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Johansen AN, Acuff SF, Strickland JC. Human laboratory models of reward in substance use disorder. Pharmacol Biochem Behav 2024; 241:173803. [PMID: 38843997 DOI: 10.1016/j.pbb.2024.173803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 04/30/2024] [Accepted: 06/01/2024] [Indexed: 06/15/2024]
Abstract
Human laboratory models in substance use disorder provide a key intermediary step between highly controlled and mechanistically informative non-human preclinical methods and clinical trials conducted in human populations. Much like preclinical models, the variety of human laboratory methods provide insights into specific features of substance use disorder rather than modelling the diverse causes and consequences simultaneously in a single model. This narrative review provides a discussion of popular models of reward used in human laboratory research on substance use disorder with a focus on the specific contributions that each model has towards informing clinical outcomes (forward translation) and analogs within preclinical models (backward translation). Four core areas of human laboratory research are discussed: drug self-administration, subjective effects, behavioral economics, and cognitive and executive function. Discussion of common measures and models used, the features of substance use disorder that these methods are purported to evaluate, unique issues for measure validity and application, and translational links to preclinical models and special considerations for studies wishing to evaluate homology across species is provided.
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Affiliation(s)
| | - Samuel F Acuff
- Recovery Research Institute, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Justin C Strickland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA.
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Hou L, Long F, Zhou W, Zhou R. Working memory training for reward processing in university students with subsyndromal depression: The influence of baseline severity of depression. Biol Psychol 2023; 184:108710. [PMID: 37820850 DOI: 10.1016/j.biopsycho.2023.108710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 10/02/2023] [Accepted: 10/06/2023] [Indexed: 10/13/2023]
Abstract
Previous studies have tentatively suggested that working memory training (WMT) has the potential to improve reward processing, but it is not known how long this improvement lasts, whether there is a lag effect, or whether it is reflected in neurophysiological indicators. In this study, 40 university students with subsyndromal depression were randomly assigned to a training group or a control group and completed a 20-day working memory training task and a simple memory task, respectively. All participants completed the Temporal Experience of Pleasure Scale (TEPS) and a doors task with electroencephalogram (EEG) signals recorded simultaneously on a pre- and post-test and a 3-month follow-up. The reward-related positivity (RewP) amplitude, theta power, and their differences between conditions (i.e., ΔRewP and Δtheta power, respectively) in the doors task were the primary outcomes, and the score on TEPS was the secondary outcome. The results indicated no group-related effects were demonstrated in primary and secondary outcomes at post-test and 3-month follow-up. Furthermore, the differences in the pre- and post-test in Δtheta power were moderated by the baseline severity of depression. This was primarily driven by the fact that the change values in the control group increased with the severity of depression, while the change values in the training group had high homogeneity. Our findings did not provide support for the effect of WMT on reward processing across the whole sample, but without intervention, there would be high heterogeneity in the change in the cognitive control ability to loss feedback, which is detrimental to individuals with high depression severity.
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Affiliation(s)
- Lulu Hou
- School of Psychology, Shanghai Normal University, Shanghai 200234, China; Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, School of Psychology and Cognitive Science, East China Normal University, Shanghai 200062, China
| | - Fangfang Long
- Department of Psychology, Nanjing University, Nanjing 210023, China
| | - Weiyi Zhou
- Department of Psychology, Nanjing University, Nanjing 210023, China
| | - Renlai Zhou
- Department of Psychology, Nanjing University, Nanjing 210023, China; State Key Laboratory of Media Convergence Production Technology and Systems, Beijing 100803, China; Department of Radiology, the Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing 210008, China.
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Maurage P, Rolland B, Pitel AL, D'Hondt F. Five Challenges in Implementing Cognitive Remediation for Patients with Substance Use Disorders in Clinical Settings. Neuropsychol Rev 2023:10.1007/s11065-023-09623-1. [PMID: 37843739 DOI: 10.1007/s11065-023-09623-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 10/02/2023] [Indexed: 10/17/2023]
Abstract
Many patients with substance use disorders (SUDs) present cognitive deficits, which are associated with clinical outcomes. Neuropsychological remediation might help rehabilitate cognitive functions in these populations, hence improving treatment effectiveness. Nardo and colleagues (Neuropsychology Review, 32, 161-191, 2022) reviewed 32 studies applying cognitive remediation for patients with SUDs. They underlined the heterogeneity and lack of quality of studies in this research field but concluded that cognitive remediation remains a promising tool for addictive disorders. We capitalize on the insights of this review to identify the key barriers that currently hinder the practical implementation of cognitive remediation in clinical settings. We outline five issues to be addressed, namely, (1) the integration of cognitive remediation in clinical practices; (2) the selection criteria and individual factors to consider; (3) the timing to be followed; (4) the priority across trained cognitive functions; and (5) the generalization of the improvements obtained. We finally propose that cognitive remediation should not be limited to classical cognitive functions but should also be extended toward substance-related biases and social cognition, two categories of processes that are also involved in the emergence and persistence of SUDs.
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Affiliation(s)
- Pierre Maurage
- Louvain Experimental Psychopathology Research Group (LEP), Psychological Science Research Institute, UCLouvain, Louvain-La-Neuve, Belgium.
- Faculté de Psychologie, Place du Cardinal Mercier, 10, B-1348, Louvain-La-Neuve, Belgium.
| | - Benjamin Rolland
- Service Universitaire d'Addictologie de Lyon (SUAL), Hospices Civils de Lyon, CH Le Vinatier, Lyon, France & PSYR, CRNL, INSERM U1028, CNRS UMR5292, UCBL1, Lyon, France
| | - Anne-Lise Pitel
- Normandie Univ, UNICAEN, INSERM, U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), Institut Blood and Brain @ Caen-Normandie, Cyceron, France
| | - Fabien D'Hondt
- Univ. Lille, Inserm, CHU Lille, U1172-LilNCog-Lille Neuroscience & Cognition, Lille, France
- Centre National de Ressources Et de Résilience Lille-Paris (CN2R), Lille, France
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Yang L, Liu W, Wang J. The hidden-zero effect in male individuals with opioid use disorder. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2023; 49:530-539. [PMID: 37433131 DOI: 10.1080/00952990.2023.2231619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 06/15/2023] [Accepted: 06/27/2023] [Indexed: 07/13/2023]
Abstract
Background: Explicitly expressing the hidden opportunity cost in intertemporal choice significantly reduces healthy participants' delay discounting - a phenomenon named the "hidden-zero effect," which is undetermined in individuals with substance use disorder (SUD).Objectives: This study aimed to determine whether the hidden-zero effect occurs among individuals with opioid use disorder (OUD) and the degree to which this effect differs between the OUD group and healthy controls.Methods: In two different experiments, Exp#1) 29 male individuals with OUD (13.5 ± 6.0 months abstinence) and 29 male controls performed an intertemporal choice task (ICT); Exp#2) 28 male individuals with OUD (17.5 ± 5.6 months abstinence) and 27 male controls performed a delay discounting task (DDT). The OUD group was recruited from a mandatory treatment, and controls from WeChat. There were two choice conditions in both two tasks: the hidden-zero (H0) condition (standard), and the explicit-zero (E0) condition (explicitly expressing opportunity cost).Results: Compared with the H0 condition, all participants' delay discounting was significantly decreased in the E0 condition (ps < .05, ηp2 = 0.254, 0.110). There was no significant difference in the changed degree between these two groups in either experiment (ps > .05). The delay discounting of the OUD group was significantly higher than that of controls only in Experiment 2 (p < .001, ηp2 = 0.376).Conclusion: This study extended the population in which the hidden-zero effect occurs to individuals with OUD. With respect to delay discounting, the hidden-zero effect benefit did not differ in OUD and control participants.
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Affiliation(s)
- Ling Yang
- Key Laboratory of Behavioral and Mental Health of Gansu Province, School of Psychology, Northwest Normal University, Lanzhou, China
| | - Wenxin Liu
- Key Laboratory of Behavioral and Mental Health of Gansu Province, School of Psychology, Northwest Normal University, Lanzhou, China
| | - Jiahao Wang
- Key Laboratory of Behavioral and Mental Health of Gansu Province, School of Psychology, Northwest Normal University, Lanzhou, China
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Barillot L, Chauvet C, Besnier M, Jaafari N, Solinas M, Chatard A. Effect of environmental enrichment on relapse rates in patients with severe alcohol use disorder: protocol for a randomised controlled trial. BMJ Open 2023; 13:e069249. [PMID: 37173113 PMCID: PMC10186436 DOI: 10.1136/bmjopen-2022-069249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 04/06/2023] [Indexed: 05/15/2023] Open
Abstract
INTRODUCTION Alcohol use disorder (AUD) ranks among the most prevalent psychiatric disorders worldwide. Despite current treatments, more than half of patients relapse within weeks after treatment. In animal models, exposure to environmental enrichment (EE) has been shown to be a promising approach to reduce relapse. However, controlled, multimodal EE is difficult to transpose to humans. To address this gap, this study aims at assessing the effectiveness of exposure to a newly designed EE protocol during AUD treatment in reducing relapse to alcohol use. Our EE will allow an enhancement of the standard intervention, and will combine several promising enrichment factors identified in the literature-physical activity, cognitive stimulation, mindfulness and virtual reality (VR). METHODS AND ANALYSIS A randomised controlled trial involving 135 participants receiving treatment for severe AUD will be conducted. Patients will be randomised to an intervention enhancement group or a control group. The enhanced intervention will consist of six 40-min sessions of EE spread over 9 days. During the first 20 min of these sessions, patients will practise mindfulness in multisensory VR, in virtual environments designed to practise mindfulness and use it to regulate craving induced by virtual cues or stress. Then, participants will practise indoor cycling combined with cognitive training exercises. The control group will undergo standard management for AUD. The primary outcome is relapse assessed at 2 weeks after treatment, using a questionnaire and biological indicators. Relapse will be defined as drinking at least five drinks per occasion or drinking at least five times a week. It is predicted that the group receiving the EE intervention will have a lower relapse rate than the control group. The secondary outcomes are relapse at 1 month and 3 months after treatment, craving and drug-seeking behaviour, mindfulness skills acquisition and the effect of the intervention enhancement on the perceived richness of the daily environment, assessed by questionnaires and neuropsychological tasks. ETHICS AND DISSEMINATION All participants have to give written informed consent to the investigator. This study is approved by the Ethics Committee Nord Ouest IV of Lille (reference number 2022-A01156-37). Results will be disseminated through presentations, peer-reviewed journals and seminar conferences. All information on ethical considerations and open science practices can be accessed at https://osf.io/b57uj/ TRIAL REGISTRATION NUMBER: NCT05577741.
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Affiliation(s)
- Lila Barillot
- Université de Poitiers, Centre de Recherches sur la Cognition et l'Apprentissage, Poitiers, Nouvelle-Aquitaine, France
- Unité de Recherche Clinique Pierre Deniker, Centre Hospitalier Henri Laborit, Poitiers, Poitou-Charentes, France
| | - Claudia Chauvet
- Unité de Recherche Clinique Pierre Deniker, Centre Hospitalier Henri Laborit, Poitiers, Poitou-Charentes, France
- Service Hospitalo-Universitaire de Psychiatrie et de Psychologie Médicale, Centre Hospitalier Henri Laborit, Poitiers, France
| | - Marc Besnier
- Université de Poitiers, Centre de Recherches sur la Cognition et l'Apprentissage, Poitiers, Nouvelle-Aquitaine, France
- Unité de Recherche Clinique Pierre Deniker, Centre Hospitalier Henri Laborit, Poitiers, Poitou-Charentes, France
| | - Nematollah Jaafari
- Université de Poitiers, Centre de Recherches sur la Cognition et l'Apprentissage, Poitiers, Nouvelle-Aquitaine, France
- Unité de Recherche Clinique Pierre Deniker, Centre Hospitalier Henri Laborit, Poitiers, Poitou-Charentes, France
| | - Marcello Solinas
- Unité de Recherche Clinique Pierre Deniker, Centre Hospitalier Henri Laborit, Poitiers, Poitou-Charentes, France
- Université de Poitiers, Laboratoire de Neurosciences Expérimentales et Cliniques U1084, Poitiers, France
| | - Armand Chatard
- Université de Poitiers, Centre de Recherches sur la Cognition et l'Apprentissage, Poitiers, Nouvelle-Aquitaine, France
- Unité de Recherche Clinique Pierre Deniker, Centre Hospitalier Henri Laborit, Poitiers, Poitou-Charentes, France
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Yazgeç E, Bora E, İngeç S, Çıray RO, Bağcı B, Alkın T. Social Cognition in Opioid Use Disorder. Subst Use Misuse 2023; 58:996-1003. [PMID: 37096303 DOI: 10.1080/10826084.2023.2201845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
Background: Opioid use disorder (OUD) is associated with significant functional impairment and neurocognitive dysfunction, but only a handful of studies have investigated social cognitive abilities in this condition. This study aimed to investigate facial emotion recognition accuracy/biases and two different aspects of theory of mind (ToM) (ToM-decoding vs ToM-reasoning) in people with recovered OUD. Methods: The participants included 32 people with recovered OUD who were on Buprenorphine + Naloxone (B/N) maintenance treatment and 32 healthy controls. In addition to neurocognitive tasks, both groups were assessed by a facial emotion recognition task, the faux pas recognition task, and the reading the mind from the eyes task. Results: In comparison to healthy controls, people on B/N maintenance treatment showed deficits in facial emotion recognition (d = 1.32) and both aspects of ToM (d = 0.87-1.21). In analyses of individual emotions, people on B/N maintenance treatment had decreased accuracy in recognition of anger and fear and had a bias to identify other emotions as sad. The duration of opioid use was robustly associated with difficulties in the recognition of anger. Conclusion: People in B/N maintenance treatment have significant difficulties in recognizing the emotions and mental states of others. Deficits in social cognition might be important for understanding the difficulties in interpersonal and social functioning in people with OUD.
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Affiliation(s)
- Emre Yazgeç
- Department of Psychiatry, Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey
| | - Emre Bora
- Department of Psychiatry, Dokuz Eylul University Medical School, Izmir, Turkey
- Department of Neuroscience Health Sciences Institute, Dokuz Eylul University, Izmir, Turkey
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia
| | - Seda İngeç
- Department of Psychiatry, Balıkesir State Hospital, Balikesir, Turkey
| | - R Oğulcan Çıray
- Department of Child and Adolescent Psychiatry, Mardin StateHospital, Mardin, Turkey
| | - Başak Bağcı
- Department of Psychiatry, Ataturk Education and Research Hospital, Izmır Kâtip Çelebi University, Izmir, Turkey
| | - Tunç Alkın
- Department of Psychiatry, Dokuz Eylul University Medical School, Izmir, Turkey
- Department of Neuroscience Health Sciences Institute, Dokuz Eylul University, Izmir, Turkey
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Wen H, Xiang X, Jiang Y, Zhang H, Zhang P, Chen R, Wei X, Dong Y, Xiao S, Lu L. Comparative efficacy of psychosocial interventions for opioid-dependent people receiving methadone maintenance treatment: A network meta-analysis. Addiction 2023; 118:1029-1039. [PMID: 36787637 DOI: 10.1111/add.16167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 01/20/2023] [Indexed: 02/16/2023]
Abstract
AIMS To estimate the efficacy of multiple psychosocial interventions for opioid-dependent people receiving methadone maintenance treatment (MMT). METHODS Systematic review and network meta-analysis of randomized controlled trials (RCTs) reporting the effect of psychosocial intervention for opioid-dependent people receiving MMT in outpatient clinics. We searched multiple data sources (Medline, Embase, Web of Science, PsycINFO and Cochrane Library) from inception to January 2022, finding 21 RCTs evaluating a total of 2862 people with opioid dependence receiving MMT. The primary outcome was the opioid-positive rate (assessed by urinalysis) and the secondary outcome was treatment discontinuation (the number of patients who terminated the study for any reason). We performed random-effects Bayesian meta-analysis. We used relative ranking using surface under the cumulative ranking method and certainty of evidence using grading of recommendations, assessment, development and evaluations. RESULTS Cognitive-behavioral therapy (CBT) [odds ratio (OR) = 0.66, 95% credible interval (CI) = 0.66-0.96; low certainty] and educational and behavioral counseling (EBC) (OR = 0.28, 95% CI = 0.12-0.25; high certainty) were more effective than treatment as usual (TAU) in efficacy. In terms of treatment discontinuation, at the end of the follow-up period there was no statistical significance among psychosocial interventions. According to the ranking probabilities, EBC might be the most effective treatment and behavioral couples' therapy (BCT) might be the best discontinuation treatment. CONCLUSIONS Educational and behavioral counseling and cognitive-behavioral therapy appear to be the most effective psychosocial interventions for opioid-dependent people receiving methadone maintenance treatment.
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Affiliation(s)
- Hao Wen
- College of Agriculture and Biology, Zhongkai University of Agriculture and Engineering, Guangzhou, China.,Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xingyu Xiang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yong Jiang
- Clinical Research and Big Data Laboratory, South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Haoyu Zhang
- Clinical Research and Big Data Laboratory, South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Peiming Zhang
- Clinical Research and Big Data Laboratory, South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Rouhao Chen
- Clinical Research and Big Data Laboratory, South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaojing Wei
- Clinical Research and Big Data Laboratory, South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yu Dong
- Clinical Research and Big Data Laboratory, South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Songhua Xiao
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Liming Lu
- Clinical Research and Big Data Laboratory, South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
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Warner NS, Hanson AC, Schulte PJ, Habermann EB, Warner DO, Mielke MM. Prescription opioids and longitudinal changes in cognitive function in older adults: A population-based observational study. J Am Geriatr Soc 2022; 70:3526-3537. [PMID: 36117241 PMCID: PMC9771934 DOI: 10.1111/jgs.18030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 07/27/2022] [Accepted: 08/14/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Opioids are frequently prescribed to alleviate pain in older adults, yet the relationships between prescription opioids and long-term cognitive function are unclear. METHODS In this analysis of the Mayo Clinic Study of Aging, a longitudinal population-based cohort study of older adults with formal neuropsychological testing and cognitive evaluations performed every 15 months, the associations between prescription opioids, global and domain-specific cognitive function, and mild cognitive impairment were evaluated through time-dependent linear mixed effects and Cox proportional hazards models. RESULTS Four thousand two hundred eighteen participants (51% male) were included with enrollment between 11/1/2004 and 4/1/2019 and median age of 76 (interquartile range 72, 82) years. Two thousand nine hundred seventy-seven subjects (71%) received at least 1 opioid prescription during a median follow-up of 7.5 (5.0, 10.7) years. Overall, there was an estimated 0.096 reduction in the global cognitive Z-score per year, including decreases of 0.050 in memory, 0.080 in language, 0.044 in visual-spatial cognition, and 0.112 in attention. In multivariable analyses, each receipt of an opioid prescription resulted in an additional -0.007 (95% CI -0.009, -0.005) change in global cognitive Z-score (p < 0.001), with significant effects seen in the domains of memory (-0.005, 95% CI -0.007, -0.003; p < 0.001), language (-0.002, 95% CI -0.003, 0.000; p = 0.024) and attention (-0.004, 95% CI -0.006, -0.002; p < 0.001) but not visual-spatial function (0.000, 95% CI -0.001, 0.001; p = 0.897). Opioid prescriptions were associated with incident mild cognitive impairment (MCI) in adjusted analysis (hazard ratio 1.21, 95% CI 1.04, 1.42; p = 0.014). CONCLUSION Prescription opioids are associated with small but statistically significant declines in long-term cognitive function in older adults, which may represent effects of opioids or other related factors.
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Affiliation(s)
- Nafisseh S. Warner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Andrew C. Hanson
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | | | - Elizabeth B. Habermann
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - David O. Warner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Michelle M. Mielke
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC
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Robledo-Castro C, Castillo-Ossa LF, Corchado JM. Artificial Cognitive Systems Applied in Executive Function Stimulation and Rehabilitation Programs: A Systematic Review. ARABIAN JOURNAL FOR SCIENCE AND ENGINEERING 2022; 48:2399-2427. [PMID: 36185593 PMCID: PMC9516512 DOI: 10.1007/s13369-022-07292-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/15/2022] [Indexed: 11/11/2022]
Abstract
This article presents a systematic review of studies on cognitive training programs based on artificial cognitive systems and digital technologies and their effect on executive functions. The aim has been to identify which populations have been studied, the characteristics of the implemented programs, the types of implemented cognitive systems and digital technologies, the evaluated executive functions, and the key findings of these studies. The review has been carried out following the PRISMA protocol; five databases have been selected from which 1889 records were extracted. The articles were filtered following established criteria, to give a final selection of 264 articles that have been used for the purposes of this study in the analysis phase. The findings showed that the most studied populations were school-age children and the elderly. The most studied executive functions were working memory and attentional processes, followed by inhibitory control and processing speed. Many programs were commercial, customizable, gamified, and based on classic tasks. Some more recent initiatives have begun to incorporate user-machine interfaces, robotics, and virtual reality, although studies on their effects remain scarce. The studies recognize multiple benefits of computerized neuropsychological stimulation and rehabilitation programs for executive functions in different age groups, but there is a lack of studies in specific population sectors and with more rigorous research designs. Supplementary Information The online version contains supplementary material available at 10.1007/s13369-022-07292-5.
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Affiliation(s)
- Carolina Robledo-Castro
- Currículo, Universidad y Sociedad Research Group, Universidad del Tolima, Calle 42 1-02, 730006299 Ibagué, Colombia
- Ingeniería del Software Research Group, Universidad Autónoma de Manizales, Antigua Estación del Ferrocarril, 170001 Manizales, Colombia
| | - Luis F. Castillo-Ossa
- Ingeniería del Software Research Group, Universidad Autónoma de Manizales, Antigua Estación del Ferrocarril, 170001 Manizales, Colombia
- Inteligencia Artificial Research Group, Universidad de Caldas, Calle 65 26-10, 170002 Manizales, Colombia
- Departamento de Ingeniería Indutrial, Universidad Nacional de Colombia Sede Manizales, Campus La Nubia, 170001 Manizales, Colombia
| | - Juan M. Corchado
- BISITE Research Group, University of Salamanca, Calle Espejo s/n, 37007 Salamanca, Spain
- Air Institute, IoT Digital Innovation Hub, 37188 Salamanca, Spain
- Department of Electronics, Information and Communication, Osaka Institute of Technology, 535-8585 Osaka, Japan
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Collado A, Felton J, Grunevski S, Doran K, Yi R. Working Memory Training Reduces Cigarette Smoking Among Low-Income Individuals With Elevated Delay Discounting. Nicotine Tob Res 2022; 24:890-896. [PMID: 35018452 PMCID: PMC9048952 DOI: 10.1093/ntr/ntac005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 11/11/2021] [Accepted: 01/05/2022] [Indexed: 01/11/2023]
Abstract
INTRODUCTION The competing neurobehavioral decision systems theory conceptualizes addictive behavior, such as cigarette smoking, as arising from the imbalance between stronger impulsive relative to weaker executive decision processes. Working memory trainings may enhance executive decision processes, yet few studies have evaluated its efficacy on substance misuse, with mixed evidence. The current study is the first to evaluate the efficacy of a working memory training on cigarette smoking. We consider the moderating role of delay discounting (DD), or the preference for smaller, immediately available rewards relative to larger, delayed rewards, which has been associated with smoking onset, progression, and resumption. The investigation focuses on individuals living in high-poverty, low-resource environments due high burden of tobacco-related disease they experience. AIMS AND METHODS The study utilized a subset of data (N = 177 individuals who smoke) generated from a randomized clinical trial that is evaluating the efficacy of working memory training for improving health-related outcomes. Participants were randomized to complete up to 15 sessions of the active, working memory training or a control training. RESULTS Findings showed that among participants who were randomized to the working memory condition, those with higher rates of baseline DD demonstrated decreases in cigarette smoking (p = .05). Conversely, individuals randomized to the control condition, who had higher rates of baseline DD exhibited increases in cigarette smoking (p = .025). CONCLUSIONS Results suggest that DD may be an important indicator of working memory training outcomes and a possible approach for effectively targeting treatments in the future. IMPLICATIONS DD is important indicator of working memory training outcomes on cigarette smoking. The findings suggest the possibility to effectively target treatments considering the impact of DD. Given that rates of DD tend to be higher among individuals from low-resource communities, and that computer-based working memory training programs are relatively low-cost and scalable, these findings suggest this approach may have specific utility for adults at heightened risk for cigarette use.This study was registered with ClinicalTrials.gov (Identifier NCT03501706).
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Affiliation(s)
- Anahi Collado
- Cofrin Logan Center for Addiction Research and Treatment, Department of Psychology, University of Kansas, Lawrence, GB, USA
| | - Julia Felton
- Center for Health Policy & Health Services Research, Henry Ford Health Systems, Detroit, MI, USA
| | - Sergej Grunevski
- Cofrin Logan Center for Addiction Research and Treatment, Department of Psychology, University of Kansas, Lawrence, GB, USA
| | - Kelly Doran
- Department of Family and Community Health, University of Maryland Baltimore, School of Nursing, Baltimore, MD, USA
| | - Richard Yi
- Cofrin Logan Center for Addiction Research and Treatment, Department of Psychology, University of Kansas, Lawrence, GB, USA
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Finn PR, Nemes L, Bailey A, Gunn RL, Wiemers EA, Redick TS. The Effects of Working Memory Versus Adaptive Visual Search Control Training on Executive Cognitive Function. JOURNAL OF COGNITIVE ENHANCEMENT 2022. [DOI: 10.1007/s41465-022-00241-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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12
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Taştekin N, Ünübol B, Yazıcı M. Clinical and Cognitive Effects of Computer Assisted Cognitive Remediation Method in Turkish Men with Opioid Use Disorder: A Randomized Controlled Trial. Subst Use Misuse 2022; 57:1973-1981. [PMID: 36151971 DOI: 10.1080/10826084.2022.2125270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Objective: Substance use disorders are associated with significant cognitive impairments causing many individual or social problems besides poor treatment outcomes. The cognitive remediation method is effective in so many neuropsychiatric disorders. This study aimed to evaluate the effects of this method among individuals with opioid use disorder. Method:60 patients diagnosed with opioid use disorder under buprenorphine-naloxone treatment and who accepted the informed consent were included. Seven patients left the study initially. 53 male patients were randomly assigned to receive treatment in the usual control or cognitive remediation-intervention group. The intervention group completed 3 to 4 sessions a week, 8 different exercises in each session, for 4 weeks, a total of 12 sessions, individually. Addiction Profile Indeks, Barrat Impulsivity Scale-SF, CGI, and Delay Discounting scores were measured before and after the 1 month cognitive Remediation practices. Three months later, patients were contacted, and their remission status was evaluated. Results: In the intervention group; 17(89.5%) people had remission and 2(10.5%) people had relapse. In the control group, 7(31.8%) individuals had remission, and 15(68.2%) had relapsed at the end of the 3 months. It was determined that craving, addiction severity, and self-reported and behavioral impulsivity values decreased while the improvement in treatment response was higher in the intervention group. Conclusion: Our results showed that the computer-assisted cognitive remediation method, in addition to buprenorphine-naloxone treatment, improves treatment response, increases remission, and has positive clinical and cognitive effects on individuals with opioid use disorder. It suggests that cognitive remediation practices can be added to the treatment programs for addiction.
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Affiliation(s)
- Nihal Taştekin
- Uskudar University, NPIstanbul Neuropsychiatry Hospital, Istanbul, Turkey
| | - Başak Ünübol
- University of Health Sciences, Erenköy Mental Health and Neurological Diseases Research and Training Hospital, Istanbul, Turkey
| | - Medine Yazıcı
- University of Health Sciences, Erenköy Mental Health and Neurological Diseases Research and Training Hospital, Istanbul, Turkey
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Piñón-Blanco A, Vergara-Moragues E, Gutiérrez-Martínez O, Fernández-Palleiro P, Rodrigues S, Rodrigues-Amorím D, Lage-López MT, González-López A, Velasquez T, Amorim M, Lloves-Moratinos M, Viéitez-Fernández I, Sabio-Fernandez G, Graña-Torralba R, Vilar-Díaz V, Carrera-Machado I, Cancelo-Martinez J, Ferreira A, Cardoso S, Rivera-Baltanás T, Otero-Lamas F, Olivares JM, Spuch C. Efficacy of the Therapeutic Game "Trisquel" in the Treatment of Patients With Substance-Related Disorders Randomized Clinical Study. Front Psychiatry 2022; 13:864511. [PMID: 35586410 PMCID: PMC9108152 DOI: 10.3389/fpsyt.2022.864511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/06/2022] [Indexed: 11/13/2022] Open
Abstract
Substance-related disorders (SRD) have been consistently associated with alterations both in cognitive and executive functions, which affect to patients' quality of life. The main objective of this work was to test the beneficial cognitive effects on patients with SRD after the implementation of "Trisquel," an intervention program in board game format. To check the effectiveness of Trisquel program, a group of people diagnosed with SRD was randomly assigned either to the experimental group or to the control group. The experimental group performed Trisquel structured sessions twice a week during 3 months, while the control group performed routinely conventional therapeutic activities with the same frequency and duration. Neuropsychological tests were done to both groups before and after the intervention. After the 3 months of intervention the experimental group showed the following statistically significant improvements for WAIS-III subtests: number key, symbol search, arithmetic, direct digits, inverse digits, total digits, letters-numbers in the processing speed index and in the working memory index. Regarding STROOP tests, statistically significant progress was observed in the phonetic fluency letter P, phonetic fluency letter M, phonetic fluency letter R subtests, word-reading and word-color subtests. The control group only obtained improvements for WAIS-III subtests of arithmetic, letters-numbers and in the working memory index. The results of this study confirm that "Trisquel" is an effective intervention program for people diagnosed with SRD, getting improvements in processing speed (psychomotor and reading), attentional subprocesses (focused and sustained) and executive functions (updating and inhibition).
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Affiliation(s)
- Adolfo Piñón-Blanco
- Drug Dependency Assistance Unit of Vigo City Council (CEDRO), Vigo, Spain.,Translational Neuroscience Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain
| | - Esperanza Vergara-Moragues
- Departamento de Psicobiología y Metodología en Ciencias del Comportamiento, Universidad Complutense de Madrid (UCM), Madrid, Spain
| | - Olga Gutiérrez-Martínez
- Translational Neuroscience Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain.,Department of Psychiatry, Hospital Álvaro Cunqueiro, SERGAS, Vigo, Spain
| | - Patricia Fernández-Palleiro
- Translational Neuroscience Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain
| | - Sonia Rodrigues
- Division for the Intervention of Addictive Behaviors and Dependencies (DICAD) of the Regional Health Administration-North of Portugal, Porto, Portugal
| | - Daniela Rodrigues-Amorím
- Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - María Teresa Lage-López
- Citizens' Association for the Fight Against Drugs (Asociación Ciudadana de Lucha Contra la Droga), A Coruña, Spain
| | - Ana González-López
- Citizens' Association for the Fight Against Drugs (Asociación Ciudadana de Lucha Contra la Droga), A Coruña, Spain
| | | | - Mónica Amorim
- Division for the Intervention of Addictive Behaviors and Dependencies (DICAD) of the Regional Health Administration-North of Portugal, Porto, Portugal
| | - Manuel Lloves-Moratinos
- Citizens' Association for the Fight Against Drugs (Asociación Ciudadana de Lucha Contra la Droga), ACLAD-Alborada, Vigo, Spain
| | | | - Gerardo Sabio-Fernandez
- Citizens' Association for the Fight Against Drugs (Asociación Ciudadana de Lucha Contra la Droga), ACLAD-Alborada, Vigo, Spain
| | | | - Vanesa Vilar-Díaz
- Ferrol Association of Drug Addictions of Ferrol (ASFEDRO), Ferrol, Spain
| | - Indalecio Carrera-Machado
- Citizens' Association for the Fight Against Drugs (Asociación Ciudadana de Lucha Contra la Droga), A Coruña, Spain
| | - Jesús Cancelo-Martinez
- Citizens' Association for the Fight Against Drugs (Asociación Ciudadana de Lucha Contra la Droga), ACLAD-Alborada, Vigo, Spain
| | - Adelino Ferreira
- Division for the Intervention of Addictive Behaviors and Dependencies (DICAD) of the Regional Health Administration-North of Portugal, Porto, Portugal
| | - Susana Cardoso
- Division for the Intervention of Addictive Behaviors and Dependencies (DICAD) of the Regional Health Administration-North of Portugal, Porto, Portugal
| | - Tania Rivera-Baltanás
- Translational Neuroscience Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain.,CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
| | - Francisco Otero-Lamas
- Drug Dependency Assistance Unit of Vigo City Council (CEDRO), Vigo, Spain.,Translational Neuroscience Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain
| | - José Manuel Olivares
- Translational Neuroscience Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain.,Department of Psychiatry, Hospital Álvaro Cunqueiro, SERGAS, Vigo, Spain.,CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
| | - Carlos Spuch
- Translational Neuroscience Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain.,CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
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14
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The effect of working memory capacity and training on intertemporal decision making in children from low-socioeconomic-status families. J Exp Child Psychol 2021; 216:105347. [PMID: 34971975 DOI: 10.1016/j.jecp.2021.105347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 10/05/2021] [Accepted: 12/05/2021] [Indexed: 12/29/2022]
Abstract
Individuals differ in their tendency to discount delayed rewards. Low socioeconomic status (SES) has been found to be associated with strong delayed reward discounting (DRD), which in turn contributes to risky decision making and adverse behaviors. However, research on possible cognitive mediators of the negative association between SES and DRD, and on effects of cognitive training in low-SES adolescents, is largely lacking. In examining Chinese adolescents (aged 11-15 years; N = 207), Study 1 assessed which aspect of working memory (WM)-simple maintenance, simple manipulation, or updating-serves as mediator, which proved to be WM updating. Based on this outcome, in Study 2 Chinese adolescents (aged 12-14 years; N = 73) with low family SES were assigned to a WM updating training condition or a control condition. All participants performed DRD and WM tasks before and after treatment. The trained adolescents showed positive training effects on DRD, and this effect was specifically correlated with beneficial training effects on performance on a WM updating transfer task. These results support the role of WM updating in DRD and might inform training programs to promote more favorable decision making in low-SES adolescents.
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Rudner T, Hume DJ, Larmuth K, Atterbury E, Rauch HGL, Kroff J. Substance use disorder and obesogenic eating: Does working memory training strengthen ability to abstain from unwanted behaviors? A systematic review. J Subst Abuse Treat 2021; 137:108689. [PMID: 34952746 DOI: 10.1016/j.jsat.2021.108689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 10/06/2021] [Accepted: 12/07/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Abstaining from unwanted behaviors requires a sufficient balance between the executive and impulsive cognitive systems. Working memory (WM) is a vital component of both systems, identified in a wide range of research as the central and dominant component of executive function. WM potentially modulates the desires, tendencies, and behaviors specific to and seen in individuals with substance use disorder (SUD) and obesogenic eating (OE). Compared to healthy populations, research has shown individuals with SUD, as well as those who display OE, to have some degree of executive dysfunction, and both conditions have far-reaching health care implications. Additionally, these deficits are associated with impulsive behavior. Research has proposed that impulsive and so-called reward-driven responses could be altered through cognitive therapy and that both SUD and OE could benefit from working memory training (WMT). METHOD In this narrative review, we systematically align extant empirical reasoning and evidence with these assumptions. Our main aim is to ascertain and summarize the value of WMT for the treatment of both SUD and food reward consummatory behaviors. As a means to include detailed narrative accounts of all papers of potential value, our thresholds for meaningful improvements in both WM and unwanted behaviors are broad. RESULTS The results from the eleven qualifying studies are as follows: Nine of ten studies show a significant positive training effect of WMT on one or more components of WM capacity; three of six eligible papers (two on alcohol and one on opioid addiction) deliver notable improvements in SUD in response to WMT. One of two suitable studies showed WMT to be a moderately efficacious form of therapy for OE. Conversely, WMT appears to have negligible therapeutic benefit for cognitive function deficits or psychopathology unrelated to WM, suggesting that WMT has unique treatment efficacy for impulsive human behaviors. CONCLUSION In conclusion, more rigorous and uniform studies on WMT and impulsive harmful behaviors are required to give proof of the benefits of this potential useful treatment.
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Affiliation(s)
- Trinity Rudner
- Division of Exercise Science and Sports Medicine (ESSM), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - David J Hume
- Division of Exercise Science and Sports Medicine (ESSM), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Kate Larmuth
- Division of Exercise Science and Sports Medicine (ESSM), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Elizabeth Atterbury
- Division of Exercise Science and Sports Medicine (ESSM), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - H G Laurie Rauch
- Division of Exercise Science and Sports Medicine (ESSM), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Jacolene Kroff
- Division of Exercise Science and Sports Medicine (ESSM), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Health through Physical Activity, Lifestyle and Sport Research Centre (HPALS), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, South Africa
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16
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Anderson AC, Youssef GJ, Robinson AH, Lubman DI, Verdejo-Garcia A. Cognitive boosting interventions for impulsivity in addiction: a systematic review and meta-analysis of cognitive training, remediation and pharmacological enhancement. Addiction 2021; 116:3304-3319. [PMID: 33751683 DOI: 10.1111/add.15469] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/09/2020] [Accepted: 02/24/2021] [Indexed: 01/05/2023]
Abstract
AIMS To evaluate and compare the effects of three cognitive boosting intervention approaches (computerised cognitive training, cognitive remediation and pharmacological cognitive enhancers) on measures of impulsive action and impulsive choice. DESIGN Systematic review and meta-analysis of publications that reported original controlled trials of cognitive boosting interventions. SETTING Studies conducted anywhere in the world. No language restrictions were applied. PARTICIPANTS Treatment-seeking adults with substance use disorder or gambling disorder. MEASUREMENTS Our primary outcome was a reduction in impulsive action or choice on a validated cognitive measure post-intervention. We assessed risk of bias using the Cochrane Collaboration tool and determined pooled estimates from published reports. We performed random-effects analyses for impulsive action and impulsive choice outcomes and planned moderator analyses. FINDINGS Of 2204 unique studies identified, 60 were included in the full-text review. Twenty-three articles were considered eligible for inclusion in the qualitative synthesis and 16 articles were included in our meta-analysis. Articles eligible for pooled analyses included five working memory training (computerised cognitive training) studies with 236 participants, three goal management training (cognitive remediation) studies with 99 participants, four modafinil (cognitive enhancer) studies with 160 participants and four galantamine (cognitive enhancer) studies with 131 participants. Study duration ranged from 5 days to 13 weeks, with immediate follow-up assessments. There were no studies identified that specifically targeted gambling disorder. We only found evidence for a benefit on impulsive choice of goal management training, although only in two studies involving 66 participants (standardised mean difference (SMD) = 0.86; 95% CI = 0.49-1.23; P = 0.02; I2 = 0%, P = 0.95). CONCLUSION Cognitive remediation, and specifically goal management training, may be an effective treatment for addressing impulsive choice in addiction. Preliminary evidence does not support the use of computerised cognitive training or pharmacological enhancers to boost impulse control in addiction.
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Affiliation(s)
- Alexandra C Anderson
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia.,Monash Addiction Research Centre, Monash University, Melbourne, Victoria, Australia
| | - George J Youssef
- Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Geelong, Victoria, Australia.,Centre for Adolescent Health, Population Health Theme, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Alex H Robinson
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia.,Monash Addiction Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Dan I Lubman
- Turning Point, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia.,Monash Addiction Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Antonio Verdejo-Garcia
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia.,Monash Addiction Research Centre, Monash University, Melbourne, Victoria, Australia
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17
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Caetano T, Pinho MS, Ramadas E, Clara C, Areosa T, Dixe MDA. Cognitive Training Effectiveness on Memory, Executive Functioning, and Processing Speed in Individuals With Substance Use Disorders: A Systematic Review. Front Psychol 2021; 12:730165. [PMID: 34489833 PMCID: PMC8418081 DOI: 10.3389/fpsyg.2021.730165] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 07/20/2021] [Indexed: 12/20/2022] Open
Abstract
Background: Cerebral neuroplasticity is compromised due to substance abuse. There is damage to neuronal areas that are involved in memory and executive functioning. Treatments with worse outcomes are often associated with cognitive deficits that have resulted from substance dependence. However, there is evidence that cognitive training can lead to improvements in cognitive functions and can be useful when treating addictions. This systematic review aims to synthesize evidence on the effectiveness of cognitive training in memory, executive functioning, and processing speed in individuals with substance use disorder (SUD). Methods: The Joanna Briggs Institute's PICO strategy was used to develop this systematic literature review. Four databases were searched (PubMed, the Cochrane Library, Web of Science, and PsycINFO) to identify controlled randomized clinical studies and quasi-experimental studies, in English, Portuguese, and Spanish, from 1985 to 2019. The literature found was examined by two independent reviewers, who assessed the quality of studies that met the inclusion criteria. The Cochrane risk-of-bias tool for the randomized controlled trials and the ROBINS-I tool for non-randomized studies were used to assess the risk of bias. In data extraction, the Cochrane Handbook for Systematic Reviews was considered. Results: From a total of 470 studies, 319 were selected for analysis after the elimination of duplicates. According to the inclusion criteria defined, 26 studies were eligible and evaluated. An evaluation was performed considering the participant characteristics, countries, substance type, study and intervention details, and key findings. Of the 26 selected studies, 14 considered only alcoholics, six included participants with various SUD (alcohol and other substances), three exclusively looked into methamphetamine-consuming users and another three into opioid/methadone users. Moreover, 18 studies found some kind of cognitive improvement, with two of these reporting only marginally significant effects. One study found improvements only in measures similar to the training tasks, and two others had ambiguous results. Conclusions: The included studies revealed the benefits of cognitive training with regard to improving cognitive functions in individuals with SUD. Memory was the most scrutinized cognitive function in this type of intervention, and it is also one of the areas most affected by substance use. Systematic Review Registration: [PROSPERO], identifier [CRD42020161039].
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Affiliation(s)
- Tânia Caetano
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal.,Center for Innovative Care and Health Technology (ciTechcare), Polytechnic of Leiria, Leiria, Portugal.,VillaRamadas International Treatment Centre, Research and Innovation Department, Leiria, Portugal
| | - Maria Salomé Pinho
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Eduardo Ramadas
- Center for Innovative Care and Health Technology (ciTechcare), Polytechnic of Leiria, Leiria, Portugal.,VillaRamadas International Treatment Centre, Research and Innovation Department, Leiria, Portugal
| | - Cátia Clara
- VillaRamadas International Treatment Centre, Research and Innovation Department, Leiria, Portugal
| | - Timóteo Areosa
- Center for Innovative Care and Health Technology (ciTechcare), Polytechnic of Leiria, Leiria, Portugal
| | - Maria Dos Anjos Dixe
- Center for Innovative Care and Health Technology (ciTechcare), Polytechnic of Leiria, Leiria, Portugal
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18
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Mistler CB, Shrestha R, Gunstad J, Sanborn V, Copenhaver MM. Adapting behavioural interventions to compensate for cognitive dysfunction in persons with opioid use disorder. Gen Psychiatr 2021; 34:e100412. [PMID: 34504995 PMCID: PMC8370499 DOI: 10.1136/gpsych-2020-100412] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 07/21/2021] [Indexed: 01/20/2023] Open
Abstract
Treatment for opioid use disorder (OUD) is often in the context of biobehavioural interventions, consisting of medication for OUD (for example, methadone and buprenorphine), which is accompanied by psychoeducation and/or behavioural therapies. Patients with OUD often display weaknesses in cognitive function that may impact the efficacy of such behavioural interventions. A review of the literature was conducted to: (1) describe common cognitive dysfunction profiles among patients with OUD, (2) outline intervention approaches for patients with OUD, (3) consider the cognitive demands that interventions place on patients with OUD and (4) identify potential accommodation strategies that may be used to optimise treatment outcomes. Cognitive profiles of patients with OUD often include weaknesses in executive function, attention, memory and information processing. Behavioural interventions require the patients' ability to learn, understand and remember information (placing specific cognitive demands on patients). Accommodation strategies are, therefore, needed for patients with challenges in one or more of these areas. Research on accommodation strategies for patients with OUD is very limited. We applied research from populations with similar cognitive profiles to form a comprehensive collection of potential strategies to compensate for cognitive dysfunction among patients with OUD. The cognitive profiles and accommodation strategies included in this review are intended to inform future intervention research aimed at improving outcomes among patients with OUD.
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Affiliation(s)
- Colleen B Mistler
- Allied Health Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Roman Shrestha
- Allied Health Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - John Gunstad
- Department of Psychology, Kent State University, Kent, Ohio, USA
| | - Victoria Sanborn
- Department of Psychology, Kent State University, Kent, Ohio, USA
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19
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Schulte MHJ, Goudriaan AE, Boendermaker WJ, van den Brink W, Wiers RW. The effect of N-acetylcysteine and working memory training on glutamate concentrations in the dACC and rACC in regular cocaine users - A randomized proof of concept study. Neurosci Lett 2021; 762:136146. [PMID: 34332028 DOI: 10.1016/j.neulet.2021.136146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 06/24/2021] [Accepted: 07/26/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Current treatments for cocaine use disorder (CUD) are not very effective and better treatments are needed. This study investigates the effectiveness of a combined intervention that targets the assumed underlying glutamate pathology in cocaine users. To this end, the combined effects of N-acetylcysteine (NAC) and working memory (WM) training on glutamate concentrations in the dorsal and rostral ACC were investigated in a randomized, double-blind placebo-controlled design. METHODS In this study, 38 regular cocaine-using men were randomized to either 25-days with 2400 mg/day NAC and WM-training or 25 days with placebo with WM-training. Cocaine use, impulsivity, and glutamate concentrations in the dACC and rACC using proton Magnetic Resonance Spectroscopy were assessed at baseline and after treatment. RESULTS Twenty-four participants completed the study, of which 9 received NAC and 15 received placebo. There were no baseline correlations of glutamate concentrations in the dACC or rACC with cocaine use measures or impulsivity. Additionally, there were no effects of NAC, WM-training, or the combination thereof on (changes in) glutamate concentrations in the dACC or rACC. DISCUSSION This randomized proof of concept study could not confirm our hypotheses. Possible explanations are insufficient power and the possible absence of deviant baseline glutamate concentrations in the included participants. Future studies should consider larger samples and a non-using control group to confirm baseline deviations in glutamate in cocaine users.
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Affiliation(s)
- Mieke H J Schulte
- Addiction, Development, and Psychopathology (ADAPT) Lab, Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Meibergdreef 5, Amsterdam, Netherlands; Faculty of Movement and Behavioral Science, Department of Clinical, Neuro- and Developmental Psychology, Section of Clinical Psychology, VU University, Amsterdam, the Netherlands.
| | - Anna E Goudriaan
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Meibergdreef 5, Amsterdam, Netherlands; Arkin, Department of Research and Quality of Care, Amsterdam, the Netherlands
| | - Wouter J Boendermaker
- Addiction, Development, and Psychopathology (ADAPT) Lab, Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands; Department of Experimental Psychology, Utrecht University, the Netherlands
| | - Wim van den Brink
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Meibergdreef 5, Amsterdam, Netherlands
| | - Reinout W Wiers
- Addiction, Development, and Psychopathology (ADAPT) Lab, Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
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20
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Rezapour T, Hatami J, Farhoudian A, Noroozi A, Daneshmand R, Sofuoglu M, Baldacchino A, Ekhtiari H. Baseline executive functions and receiving cognitive rehabilitation can predict treatment response in people with opioid use disorder. J Subst Abuse Treat 2021; 131:108558. [PMID: 34366202 DOI: 10.1016/j.jsat.2021.108558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 06/23/2021] [Accepted: 07/04/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Impaired cognitive functions, particularly executive function, predicts poor treatment success in people with substance use disorders. The current study investigated the effect of receiving adjunct cognitive rehabilitation and baseline executive function (EF) measures on treatment response among people with opioid use disorder (OUD). METHOD The analysis sample consisted of 113 participants with OUD who were discharged from a compulsory court-mandated methadone maintenance treatment (MMT) and followed for 3 months. We used the Backward digit span/Auditory verbal learning, Stroop, and Trail making tests to assess the three measures of EF, including working memory, inhibition, and shifting, respectively. Treatment response was operationalized as (1) treatment retention and (2) the number of positive urine tests for morphine during 3-month follow-up periods. The study used Cox's proportional hazards model and linear mixed model to identify predictive factors. RESULTS Lower Stroop interference scores predicted increased length of stay in treatment (χ2 = 33.15, P < 0.001). The linear mixed model showed that scores on auditory verbal learning test and group intervention predicted the number of positive urine tests during a 3-month follow-up. CONCLUSION Working memory and inhibitory control, as well as receiving cognitive rehabilitation, could be potentially considered as predictors of treatment response for newly MMT admitted patients with OUD. Assessment of EF before treatment initiation may inform treatment providers about patient's cognitive deficits that may interfere with therapeutic interventions.
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Affiliation(s)
- Tara Rezapour
- Department of Cognitive Psychology, Institute for Cognitive Science Studies, Tehran, Iran
| | - Javad Hatami
- Department of Psychology, Faculty of Psychology and Education, University of Tehran, Tehran, Iran
| | - Ali Farhoudian
- Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Noroozi
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Reza Daneshmand
- Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mehmet Sofuoglu
- Department of Psychiatry, School of Medicine, Yale University, CT, USA; VA Connecticut Healthcare System, West Haven, CT, USA
| | - Alex Baldacchino
- University of St Andrews, School of Medicine, Division of Population and Behavioral Sciences, St Andrews, Scotland, UK
| | - Hamed Ekhtiari
- Laureate Institute for Brain Research (LIBR), Tulsa, OK, USA.
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21
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Ekhtiari H, Rezapour T, Sawyer B, Yeh HW, Kuplicki R, Tarrasch M, Paulus MP, Aupperle R. Neurocognitive Empowerment for Addiction Treatment (NEAT): study protocol for a randomized controlled trial. Trials 2021; 22:330. [PMID: 33962675 PMCID: PMC8106153 DOI: 10.1186/s13063-021-05268-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 04/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neurocognitive deficits (NCDs) and associated meta-cognition difficulties associated with chronic substance use often delay the learning and change process necessary for addiction recovery and relapse prevention. However, very few cognitive remediation programs have been developed to target NCDs and meta-cognition for substance users. The study described herein aims to investigate the efficacy of a multi-component neurocognitive rehabilitation and awareness program termed "Neurocognitive Empowerment for Addiction Treatment" (NEAT). NEAT is a fully manualized, cartoon-based intervention involving psychoeducation, cognitive practice, and compensatory strategies relevant across 10 major cognitive domains, including aspects of attention, memory, executive functions, and decision-making. METHOD/DESIGN In a single-blind randomized controlled trial (RCT), 80 female opioid and/or methamphetamine users will be recruited from an addiction recovery program providing an alternative to incarceration for women with substance use-related offenses. Eight groups of 9-12 participants will be randomized into NEAT or treatment-as-usual (TAU). NEAT involves 14 90-min sessions, delivered twice weekly. The primary outcome is change in self-reported drug craving from before to after intervention using Obsessive Compulsive Drug Use Scale. Secondary and exploratory outcomes include additional psychological, neurocognitive, and structural and functional neuroimaging measures. Clinical measures will be performed at five time points (pre- and post-intervention, 3-, 6-, and 12-month follow-up); neuroimaging measures will be completed at pre- and post-intervention. DISCUSSION The present RCT is the first study to examine the efficacy of an adjunctive neurocognitive rehabilitation and awareness program for addiction. Results from this study will provide initial information concerning potential clinical efficacy of the treatment, as well as delineate neural mechanisms potentially targeted by this novel intervention. TRIAL REGISTRATION ClinicalTrials.gov NCT03922646 . Registered on 22 April 2019.
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Affiliation(s)
- Hamed Ekhtiari
- Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, OK, 74136, USA.
| | - Tara Rezapour
- Institute for Cognitive Science Studies, Tehran, Iran
| | - Brionne Sawyer
- Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, OK, 74136, USA
| | | | - Rayus Kuplicki
- Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, OK, 74136, USA
| | | | - Martin P Paulus
- Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, OK, 74136, USA
| | - Robin Aupperle
- Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, OK, 74136, USA
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22
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Towe SL, Hartsock JT, Xu Y, Meade CS. Web-Based Cognitive Training to Improve Working Memory in Persons with Co-Occurring HIV Infection and Cocaine Use Disorder: Outcomes from a Randomized Controlled Trial. AIDS Behav 2021; 25:1542-1551. [PMID: 32749625 DOI: 10.1007/s10461-020-02993-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Neurocognitive impairment (NCI) remains a persistent complication of HIV disease that nearly half of persons with HIV experience, and rates are even higher in persons who use substances such as cocaine. Cognitive training is a promising intervention for HIV-associated NCI. In this randomized controlled trial, we examined the feasibility and effectiveness of a web-based cognitive training program to improve working memory in a sample of 58 persons with HIV and cocaine use disorder. Participants were randomly assigned to either the experimental working memory training arm or the attention control training arm and completed up to 48 daily sessions over 10 weeks. Overall, treatment completion (74%) and retention rates (97%) were high, and participant feedback indicated the intervention was acceptable. Our results show that the intervention successfully reduced working memory deficits in the experimental arm relative to the control arm. Our findings support both the feasibility and effectiveness of cognitive training in this population.
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Affiliation(s)
- Sheri L Towe
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Box 102848, Durham, NC, 27710, USA.
| | - Jeremiah T Hartsock
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Box 102848, Durham, NC, 27710, USA
| | - Yunan Xu
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Box 102848, Durham, NC, 27710, USA
| | - Christina S Meade
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Box 102848, Durham, NC, 27710, USA
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23
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Loganathan K, Ho ETW. Value, drug addiction and the brain. Addict Behav 2021; 116:106816. [PMID: 33453587 DOI: 10.1016/j.addbeh.2021.106816] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 11/17/2020] [Accepted: 01/02/2021] [Indexed: 12/15/2022]
Abstract
Over the years, various models have been proposed to explain the psychology and biology of drug addiction, built primarily around the habit and compulsion models. Recent research indicates drug addiction may be goal-directed, motivated by excessive valuation of drugs. Drug consumption may initially occur for the sake of pleasure but may transition to a means of escaping withdrawal, stress and negative emotions. In this hypothetical paper, we propose a value-based neurobiological model for drug addiction. We posit that during dependency, the value-based decision-making system in the brain is not inactive but has instead prioritized drugs as the reward of choice. In support of this model, we consider the role of valuation in choice, its influence on pleasure and punishment, and how valuation is contrasted in impulsive and compulsive behaviours. We then discuss the neurobiology of value, beginning with the dopaminergic system and its relationship with incentive salience before moving to brain-wide networks involved in valuation, control and prospection. These value-based neurobiological components are then integrated into the cycle of addiction as we consider the development of drug dependency from a valuation perspective. We conclude with a discussion of cognitive interventions utilizing value-based decision-making, highlighting not just advances in recalibrating the valuation system to focus on non-drug rewards, but also areas for improvement in refining this approach.
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Affiliation(s)
- Kavinash Loganathan
- Centre for Intelligent Signal & Imaging, Universiti Teknologi PETRONAS, Perak, Malaysia.
| | - Eric Tatt Wei Ho
- Centre for Intelligent Signal & Imaging, Universiti Teknologi PETRONAS, Perak, Malaysia; Dept of Electrical & Electronics Engineering, Universiti Teknologi PETRONAS, Perak, Malaysia
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24
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Nardo T, Batchelor J, Berry J, Francis H, Jafar D, Borchard T. Cognitive Remediation as an Adjunct Treatment for Substance Use Disorders: A Systematic Review. Neuropsychol Rev 2021; 32:161-191. [PMID: 33871785 DOI: 10.1007/s11065-021-09506-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 04/06/2021] [Indexed: 11/28/2022]
Abstract
Substance use disorders are associated with diverse neuropsychological impairments, with deficits in memory and executive functioning commonly observed. Cognitive remediation has been shown to be effective in other populations with cognitive impairments in these domains, including those with psychiatric disorders and acquired brain injuries, and it has been hypothesised to be similarly effective for those in treatment for substance use disorders. We aimed to systematically review the evidence for cognitive remediation interventions administered as an adjunct treatment to substance use rehabilitation. Studies were included if participants were receiving substance use treatment, if improving cognitive functioning was the main focus of the intervention and if they used an experimental design with a control condition receiving treatment-as-usual or an active control intervention. Two independent reviewers agreed on the final selection of 32 studies, encompassing cognitive remediation for working memory, memory, executive functioning and general cognition. Significant differences between intervention and control groups for cognitive test results and treatment outcomes were extracted and compared across treatment approaches. The review found considerable heterogeneity across studies, including in the types of interventions, the nature of participants and the outcome measures used. Further, a lack of quality studies with sufficient power meant that limited conclusions could be drawn, highlighting a need for further replication and research. However, findings indicate that cognitive remediation remains a promising potential avenue for improving cognition and treatment outcomes for those in treatment for substance use disorders. Protocol submitted prospectively to PROSPERO 30.09.2019, CRD42020150978.
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Affiliation(s)
- Talia Nardo
- Macquarie University, North Ryde, NSW, 2109, Australia.
| | | | - Jamie Berry
- Macquarie University, North Ryde, NSW, 2109, Australia.,Advanced Neuropsychological Treatment Services, Strathfield South, NSW, 2136, Australia
| | | | - Deyyan Jafar
- Macquarie University, North Ryde, NSW, 2109, Australia
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25
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Hurel E, Grall-Bronnec M, Thiabaud E, Saillard A, Hardouin JB, Challet-Bouju G. A Case-Control Study on Behavioral Addictions and Neurocognition: Description of the BANCO and BANCO2 Protocols. Neuropsychiatr Dis Treat 2021; 17:2369-2386. [PMID: 34321880 PMCID: PMC8312511 DOI: 10.2147/ndt.s292490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 02/19/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Only two behavioral addictions (BAs) are currently recognized in international classifications (gambling disorder: GbD; gaming disorder: GmD), while some of them await further investigation (food addiction: FA; sexual addiction: SA). Neurocognitive functioning is considered a risk factor for BAs. Research is quite abundant for GbD and highlights specific deficits in several cognitive functions. Nevertheless, grey areas still exist. The aim of this research programme is to investigate the neurocognitive profiles of patients presenting with various BAs and to establish parallels between different forms of BA to achieve a common addiction concept. METHODS AND ANALYSIS This research program is composed of two studies sharing the same methodology but focusing on different samples: the BANCO study aims to include 30 individuals with a GbD, whereas the BANCO2 study aims to include 30 individuals with a GmD, 30 with a SA, and 30 with a FA. Moreover, for each BA group, 30 healthy controls will be recruited, matched by sex, age and education level. Several cognitive tasks will be completed by participants. Cue reactivity and physiological responses, as well as clinical data regarding addiction characteristics and personality, will also be investigated. A composite score based on the cognitive tasks will be computed using principal component analysis (PCA). Overall cognitive performance and detailed performance on the different cognitive tasks will be compared between individuals with BAs and their matched healthy controls using linear models with random effects. Comparisons will also be made between BA groups to investigate specific alterations associated with each disorder. DISCUSSION The results of this research programme will impact both research and clinical areas by (i) providing new knowledge for discussions regarding the inclusion of BAs under the spectrum of addictive disorders; (ii) improving understanding of addiction mechanisms in general; (iii) providing clarity in the grey areas in neurocognitive research on BAs and improving the understanding of less studied BAs, (iv) guiding clinicians to propose therapeutic alternatives and complementary programmes. TRIAL REGISTRATION BANCO study (ClinicalTrials.gov NCT03202290); BANCO2 study (ClinicalTrials.gov NCT03967418).
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Affiliation(s)
- Elodie Hurel
- CHU Nantes, Addictology and Psychiatry Department, Nantes, France.,INSERM U1246 SPHERE (methodS in Patient-centered outcomes & HEalth ResEarch), University of Nantes, University of Tours, Nantes, France
| | - Marie Grall-Bronnec
- CHU Nantes, Addictology and Psychiatry Department, Nantes, France.,INSERM U1246 SPHERE (methodS in Patient-centered outcomes & HEalth ResEarch), University of Nantes, University of Tours, Nantes, France
| | - Elsa Thiabaud
- CHU Nantes, Addictology and Psychiatry Department, Nantes, France
| | - Anaïs Saillard
- CHU Nantes, Addictology and Psychiatry Department, Nantes, France
| | - Jean-Benoît Hardouin
- INSERM U1246 SPHERE (methodS in Patient-centered outcomes & HEalth ResEarch), University of Nantes, University of Tours, Nantes, France
| | - Gaëlle Challet-Bouju
- CHU Nantes, Addictology and Psychiatry Department, Nantes, France.,INSERM U1246 SPHERE (methodS in Patient-centered outcomes & HEalth ResEarch), University of Nantes, University of Tours, Nantes, France
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26
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Zhao X, Wang L, Maes JH. Training and transfer effects of working memory training in male abstinent long-term heroin users. Addict Behav Rep 2020; 12:100310. [PMID: 33364318 PMCID: PMC7752720 DOI: 10.1016/j.abrep.2020.100310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/28/2020] [Indexed: 10/26/2022] Open
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27
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McHugh RK, Nguyen MD, Fitzmaurice GM, Dillon DG. Behavioral strategies to reduce stress reactivity in opioid use disorder: Study design. Health Psychol 2020; 39:806-814. [PMID: 32833482 DOI: 10.1037/hea0000862] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES More than 2 million people in the United States had an opioid use disorder in 2017. Treatment for opioid use disorder-particularly medication combined with psychosocial support-is effective for reducing opioid use and decreasing overdose risk. However, approximately 50% of people who receive treatment will relapse or drop out. Stress reactivity, defined as the subjective and physiological response to stress, is heightened in people with opioid use disorder and higher stress reactivity is associated with poorer outcomes. Preliminary studies suggest that stress reactivity may be a key mechanistic target for improving outcomes. This article describes the design of an ongoing study examining behavioral strategies for reducing stress reactivity in adults with opioid use disorder. Our objective is to test the efficacy of two behavioral strategies for reducing stress reactivity and enhancing behavioral persistence in the context of stress (distress tolerance). METHOD We will recruit 120 adults with opioid use disorder and randomly assign them to brief training in (a) cognitive reappraisal, (b) affect labeling, or (c) a psychoeducational control. Participants will receive the training intervention followed by a laboratory stressor during which they will be instructed to apply the trained skill. RESULTS Subjective and physiological responses to stress will be measured as indices of stress reactivity and the stressor task will include a behavioral persistence component as a measure of distress tolerance. CONCLUSIONS The ultimate goal of this study is to inform the development of behavioral interventions that can be used as an adjunct to medication-based treatment for opioid use disorder. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | | | | | - Daniel G Dillon
- Center for Depression Anxiety and Stress Research, McLean Hospital
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28
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Abstract
In this targeted review, we summarize current knowledge on substance-use disorder
(SUD)-related cognitive deficits, the link between these deficits and clinical outcomes,
and the cognitive training, remediation, and pharmacological approaches that have the
potential to rescue cognition. We conclude that: (i) people with SUDs have moderate
deficits in memory, attention, executive functions, and decision-making (including
reward expectancy, valuation, and learning); (ii) deficits in higher-order executive
functions and decision-making are significant predictors of relapse; (iii) cognitive
training programs targeting reward-related appetitive biases, cognitive remediation
strategies targeting goal-based decision-making, and pharmacotherapies targeting memory,
attention, and impulsivity have potential to rescue SUD-related cognitive deficits. We
suggest avenues for future research, including developing brief, clinically oriented
harmonized cognitive testing suites to improve individualized prediction of treatment
outcomes; computational modeling that can achieve deep phenotyping of cognitive subtypes
likely to respond to different interventions; and phenotype-targeted cognitive,
pharmacological, and combined interventions. We conclude with a tentative model of
neuroscience-informed precision medicine.
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Affiliation(s)
| | - Gloria Garcia-Fernandez
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia; Department of Psychology, University of Oviedo, Spain
| | - Geert Dom
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University (UA), Antwerp, Belgium
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29
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Khemiri L, Larsson H, Kuja-Halkola R, D'Onofrio BM, Lichtenstein P, Jayaram-Lindström N, Latvala A. Association of parental substance use disorder with offspring cognition: a population family-based study. Addiction 2020; 115:326-336. [PMID: 31503371 DOI: 10.1111/add.14813] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 06/24/2019] [Accepted: 09/03/2019] [Indexed: 01/20/2023]
Abstract
AIMS To assess whether parental substance use disorder (SUD) is associated with lower cognitive ability in offspring, and whether the association is independent of shared genetic factors. DESIGN A population family-based cohort study utilizing national Swedish registries. Linear regression with increased adjustment of covariates was performed in the full population. In addition, the mechanism of the association was investigated with children-of-sibling analyses using fixed-effects regression with three types of sibling parents with increasing genetic relatedness (half-siblings, full siblings and monozygotic twins). SETTING AND PARTICIPANTS A total of 3 004 401 people born in Sweden between 1951 and 1998. MEASUREMENTS The exposure variable was parental SUD, operationalized as having a parent with life-time SUD diagnosis or substance-related criminal conviction in the National Patient Register or Crime Register, respectively. Outcomes were cognitive test score at military conscription and final school grades when graduating from compulsory school. Covariates included in the analyses were sex, birth year, parental education, parental migration status and parental psychiatric comorbid diagnoses. FINDINGS In the full population, parental SUD was associated with decreased cognitive test stanine scores at conscription [4.56, 95% confidence interval (CI) = 4.55-4.57] and lower Z-standardized school grades (-0.43, 95% CI = -0.43 to -0.42) compared to people with no parental SUD (cognitive test: 5.17, 95% CI = 5.17-5.18; grades: 0.09, 95% CI = 0.08-0.09). There was evidence of a dose-response relationship, in that having two parents with SUD (cognitive test: 4.17, 95% CI = 4.15-4.20; grades: -0.83, 95% CI = -0.84 to -0.82) was associated with even lower cognitive ability than having one parent with SUD (cognitive test: 4.60, 95% CI = 4.59-4.60; grades: -0.38, 95% CI = -0.39 to -0.380). In the children-of-siblings analyses when accounting for genetic relatedness, these negative associations were attenuated, suggestive of shared underlying genetic factors. CONCLUSIONS There appear to be shared genetic factors between parental substance use disorder (SUD) and offspring cognitive function, suggesting that cognitive deficits may constitute a genetically transmitted risk factor in SUD.
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Affiliation(s)
- Lotfi Khemiri
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Brian M D'Onofrio
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Nitya Jayaram-Lindström
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Stockholm, Sweden
| | - Antti Latvala
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
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30
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Bickel WK, Athamneh LN, Snider SE, Craft WH, DeHart WB, Kaplan BA, Basso JC. Reinforcer Pathology: Implications for Substance Abuse Intervention. Curr Top Behav Neurosci 2020; 47:139-162. [PMID: 32462615 DOI: 10.1007/7854_2020_145] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The rate at which individuals discount future rewards (i.e., discounting rate) is strongly associated with their propensity for substance abuse as well as myriad other negative health behaviors. An excessive preference for immediately available rewards suggests a shortened time horizon in which immediate rewards are overvalued and future, potentially negative consequences are undervalued. This review outlines Reinforcer Pathology Theory (i.e., the interaction between excessive preference for immediately available rewards and the overvaluation of a particular commodity that offers brief, intense reinforcement), its neurobiological/behavioral underpinnings, and its implications for treating substance use disorders. In doing so, the current review provides an overview of a variety of ways in which interventions have been used to manipulate aspects of reinforcer pathology in an individual, including narrative theory, framing manipulations, and neuromodulation (e.g., working memory training, TMS) which may serve as promising avenues for the modulation of the temporal window and/or valuation of reinforcers.
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Affiliation(s)
- Warren K Bickel
- Addiction Recovery Research Center, Fralin Biomedical Research Institute, Roanoke, VA, USA. .,Center for Transformative Research on Health Behaviors, Fralin Biomedical Research Institute, Roanoke, VA, USA.
| | - Liqa N Athamneh
- Addiction Recovery Research Center, Fralin Biomedical Research Institute, Roanoke, VA, USA.,Graduate Program in Translational Biology, Medicine, and Health, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - Sarah E Snider
- Addiction Recovery Research Center, Fralin Biomedical Research Institute, Roanoke, VA, USA
| | - William H Craft
- Addiction Recovery Research Center, Fralin Biomedical Research Institute, Roanoke, VA, USA.,Graduate Program in Translational Biology, Medicine, and Health, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - William B DeHart
- Addiction Recovery Research Center, Fralin Biomedical Research Institute, Roanoke, VA, USA
| | - Brent A Kaplan
- Addiction Recovery Research Center, Fralin Biomedical Research Institute, Roanoke, VA, USA
| | - Julia C Basso
- Addiction Recovery Research Center, Fralin Biomedical Research Institute, Roanoke, VA, USA
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31
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Scholten H, Scheres A, de Water E, Graf U, Granic I, Luijten M. Behavioral trainings and manipulations to reduce delay discounting: A systematic review. Psychon Bull Rev 2019; 26:1803-1849. [PMID: 31270766 PMCID: PMC6863952 DOI: 10.3758/s13423-019-01629-2] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In everyday decision-making, individuals make trade-offs between short-term and long-term benefits or costs. Depending on many factors, individuals may choose to wait for larger delayed reward, yet in other situations they may prefer the smaller, immediate reward. In addition to within-subject variation in the short-term versus long-term reward trade-off, there are also interindividual differences in delay discounting (DD), which have been shown to be quite stable. The extent to which individuals discount the value of delayed rewards turns out to be associated with important health and disorder-related outcomes: the more discounting, the more unhealthy or problematic choices. This has led to the hypothesis that DD can be conceptualized as trans-disease process. The current systematic review presents an overview of behavioral trainings and manipulations that have been developed to reduce DD in human participants aged 12 years or older. Manipulation studies mostly contain one session and measure DD directly after the manipulation. Training studies add a multiple session training component that is not per se related to DD, in between two DD task measurements. Ninety-eight studies (151 experiments) were identified that tested behavioral trainings and manipulations to decrease DD. Overall, results indicated that DD can be decreased, showing that DD is profoundly context dependent and changeable. Most promising avenues to pursue in future research seem to be acceptance-based/mindfulness-based trainings, and even more so manipulations involving a future orientation. Limitations and recommendations are discussed to identify the mechanistic processes that allow for changes in discount rate and behavior accordingly.
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Affiliation(s)
- Hanneke Scholten
- Behavioural Science Institute, Radboud University, P.O. Box 9104, 6500, HE, Nijmegen, The Netherlands.
| | - Anouk Scheres
- Behavioural Science Institute, Radboud University, P.O. Box 9104, 6500, HE, Nijmegen, The Netherlands
| | - Erik de Water
- Behavioural Science Institute, Radboud University, P.O. Box 9104, 6500, HE, Nijmegen, The Netherlands
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Uta Graf
- Behavioural Science Institute, Radboud University, P.O. Box 9104, 6500, HE, Nijmegen, The Netherlands
| | - Isabela Granic
- Behavioural Science Institute, Radboud University, P.O. Box 9104, 6500, HE, Nijmegen, The Netherlands
| | - Maartje Luijten
- Behavioural Science Institute, Radboud University, P.O. Box 9104, 6500, HE, Nijmegen, The Netherlands
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32
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Sampedro-Piquero P, Ladrón de Guevara-Miranda D, Pavón FJ, Serrano A, Suárez J, Rodríguez de Fonseca F, Santín LJ, Castilla-Ortega E. Neuroplastic and cognitive impairment in substance use disorders: a therapeutic potential of cognitive stimulation. Neurosci Biobehav Rev 2019; 106:23-48. [DOI: 10.1016/j.neubiorev.2018.11.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 10/15/2018] [Accepted: 11/23/2018] [Indexed: 01/08/2023]
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33
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Miranda R, Wemm SE, Treloar Padovano H, Carpenter RW, Emery NN, Gray JC, Mereish EH. Weaker Memory Performance Exacerbates Stress-Induced Cannabis Craving in Youths' Daily Lives. Clin Psychol Sci 2019; 7:1094-1108. [PMID: 31737439 DOI: 10.1177/2167702619841976] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Theories of addiction posit that stimuli associated with drug use, including both exteroceptive (e.g., paraphernalia) and interoceptive (e.g., feeling tense or "stressed"), evoke craving and contribute to the pathogenesis of substance misuse. Control over drug cue response and stress is essential for moderating use. Building from laboratory data supporting associations between cue exposure, stress, and craving, this study tested whether these associations generalize to real-world settings and examined whether a well-vetted neurocognitive control capacity, i.e., working memory (WM), moderated associations. Youth (N = 85; 15-24 years) completed baseline and ecological momentary assessments. Cue exposure and participants' average stress predicted higher craving. Youth with weaker WM experienced stronger craving at higher-stress moments but not when faced with cues. Interactions were present for both previous-moment and same-moment stress. Craving among adolescents with stronger WM was not swayed by momentary stress. Findings suggest stronger WM protects against craving at more stressful moments.
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Affiliation(s)
- Robert Miranda
- Center for Alcohol and Addiction Studies, Brown University
| | | | | | | | - Noah N Emery
- Center for Alcohol and Addiction Studies, Brown University
| | - Joshua C Gray
- Department of Medical and Clinical Psychology, Uniformed Services University
| | - Ethan H Mereish
- Center for Alcohol and Addiction Studies, Brown University; Department of Health Studies, American University
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Carroll KM, Nich C, DeVito EE, Shi JM, Sofuoglu M. Galantamine and Computerized Cognitive Behavioral Therapy for Cocaine Dependence: A Randomized Clinical Trial. J Clin Psychiatry 2019; 79:17m11669. [PMID: 29286595 PMCID: PMC5866530 DOI: 10.4088/jcp.17m11669] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 07/11/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To examine whether galantamine, a cognitive-enhancing medication that is both acetylcholinesterase inhibitor and agonist at nicotinic acetylcholine receptors, is effective at improving cocaine use outcomes and cognitive functioning, alone and in combination with computerized cognitive behavioral therapy (CBT). METHOD A 12-week, randomized 2 × 2, factorial trial was conducted to evaluate galantamine versus placebo (double-blind) and computerized CBT plus standard methadone treatment versus standard methadone treatment alone in a community-based methadone maintenance program (September 2009-April 2015). One hundred twenty individuals diagnosed with DSM-IV cocaine use disorder were randomly assigned to the following conditions: (1) galantamine (8 mg/d) plus standard methadone maintenance treatment (treatment as usual [TAU]), (2) placebo plus TAU, (3) galantamine plus computerized CBT plus TAU, or (4) placebo plus computerized CBT plus TAU; medication administration was supervised at the time of daily methadone dosing. The primary cocaine use outcome was change in percent days of abstinence over time. Number of cocaine-negative urine toxicology screens submitted and cognitive function were secondary outcomes. RESULTS Random effect regression analysis indicated significant reductions in frequency of cocaine use over time, with significant treatment-by-time effects for both galantamine over placebo (F = 5.3, P = .02, d = 0.34) and computerized CBT over standard methadone treatment (F = 4.2, P = .04, d = 0.30) but no evidence of significant benefit of the combination over either treatment alone. Pretreatment to posttreatment comparisons of multiple indices of cognitive functioning, including sustained attention, indicated no benefit of galantamine over placebo. CONCLUSIONS Findings suggest benefits of galantamine and computerized CBT for reducing cocaine use in this sample. Although galantamine did not improve measures of cognitive function in this sample, multiple measures of cognitive function were associated with cocaine use outcomes, underlining the significance of cognitive function in cocaine treatment outcomes. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00809835.
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Affiliation(s)
- Kathleen M Carroll
- Yale University School of Medicine, 40 Temple St, Ste 6C, New Haven, CT 06510.
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Charla Nich
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Elise E DeVito
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Julia M Shi
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
- APT Foundation, New Haven, Connecticut, USA
| | - Mehmet Sofuoglu
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
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Stanger C, Scherer EA, Vo HT, Babbin SF, Knapp AA, McKay JR, Budney AJ. Working memory training and high magnitude incentives for youth cannabis use: A SMART pilot trial. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2019; 34:31-39. [PMID: 31246068 DOI: 10.1037/adb0000480] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The purpose of this sequential multiple-assignment randomization treatment pilot study was to examine if (a) adding working memory training to contingency management (CM) for youth with cannabis use disorder (CUD) and (b) switching nonresponding youth to higher magnitude CM incentives boosts outcomes. In Phase 1, youth with CUD (n = 59, M age = 16, male = 71%) attending an intensive outpatient program were randomly assigned to 14 weeks of CM only or CM plus working memory training (WMT). In Week 4, a Phase 2 treatment was assigned. Those with negative urine drug tests (responders) continued in their Phase 1 treatment. Those who were drug positive (nonresponders) were randomly assigned to remain in their Phase 1 treatment or to higher magnitude CM. Zero-inflated negative binomial models comparing those assigned to CM versus CM + WMT indicated no differences in the likelihood of having ≥ 1 week of continuous abstinence or longer abstinence duration. Those assigned to WMT showed greater but nonsignificant improvements in working memory (n = 35; β = .69, p = .06). Working memory improvements were associated with achieving any abstinence (odds ratio = 3.50, 95% CI [1.01, 12.10], p = .05). Phase 2 randomization to higher magnitude CM did not boost outcomes. Overall results suggest that WMT appears promising, but the sample size was small, attrition was high, and replication is important. Alternative strategies should continue to be explored to improve outcomes for adolescent substance use disorders, such as different approaches for nonresponders, tailoring to other baseline or response characteristics, or more robust first-line interventions. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Schulte MHJ, Kaag AM, Boendermaker WJ, van den Brink W, Goudriaan AE, Wiers RW. The effect of N-acetylcysteine and working memory training on neural mechanisms of working memory and cue reactivity in regular cocaine users. Psychiatry Res Neuroimaging 2019; 287:56-59. [PMID: 30991248 DOI: 10.1016/j.pscychresns.2019.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 03/20/2019] [Accepted: 03/20/2019] [Indexed: 12/23/2022]
Abstract
The current study investigated the combined effects of N-acetylcysteine and working memory (WM) training on behavioral and neural mechanisms of cue reactivity and WM in cocaine users in a randomized, double-blind design. Twenty-four of 38 cocaine-using men completed a 25-day treatment with either 2400 mg/day NAC or placebo. Both groups performed WM-training. During pre- and post-test lab-visits, neural mechanisms of cue reactivity and WM, and cue-induced craving and WM performance were assessed. Additionally, exploratory whole brain analyses were performed. Overall, the hypotheses were not confirmed, possibly due to small sample size, low WM-training adherence and/or ongoing substance use.
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Affiliation(s)
- Mieke H J Schulte
- Addiction, Development, and Psychopathology (ADAPT) lab, Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands; Department of Psychiatry, Academic Medical Center, University of Amsterdam, the Netherlands; Faculty of Movement and Behavioral Science, Department of Clinical, Neuro-, and Developmental Psychology, Section of Clinical Psychology, VU University, Amsterdam, the Netherlands.
| | - Anne Marije Kaag
- Addiction, Development, and Psychopathology (ADAPT) lab, Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands; Department of Psychiatry, Academic Medical Center, University of Amsterdam, the Netherlands
| | - Wouter J Boendermaker
- Addiction, Development, and Psychopathology (ADAPT) lab, Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands; Department of Experimental Psychology, Utrecht University, the Netherlands
| | - Wim van den Brink
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, the Netherlands
| | - Anna E Goudriaan
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, the Netherlands; Arkin Mental Health, Amsterdam, the Netherlands
| | - Reinout W Wiers
- Addiction, Development, and Psychopathology (ADAPT) lab, Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
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Strickland JC, Hill JC, Stoops WW, Rush CR. Feasibility, Acceptability, and Initial Efficacy of Delivering Alcohol Use Cognitive Interventions via Crowdsourcing. Alcohol Clin Exp Res 2019; 43:888-899. [PMID: 30888705 DOI: 10.1111/acer.13987] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 02/10/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND Inhibitory control training and working memory training are 2 cognitive interventions that have been considered for alcohol use disorder (AUD). Existing studies have typically relied on small samples that preclude the evaluation of small effects. Crowdsourcing is a sampling method that can address these limitations by effectively and efficiently recruiting large samples with varying health histories. This study tested the feasibility and acceptability of delivering cognitive training interventions via crowdsourcing. METHODS Participants with AUD were recruited from the crowdsourcing website Amazon Mechanical Turk (mTurk) (ClinicalTrials.gov; NCT03438539). Following completion of a baseline survey, participants were randomized to an inhibitory control, working memory, or control training condition. Participants were asked to complete training tasks daily over a 2-week period. Follow-up assessments evaluating acceptability measures and alcohol and soda consumption were completed immediately following and 2 weeks after training. RESULTS Response rates were satisfactory over the 2-week intervention period (65% of training tasks completed), and performance on training tasks was consistent with expected effects. A majority of participants indicated that they were satisfied with the study procedures (94.6%), would participate again (97.4%), and would consider incorporating the training task in their daily life (81.1%). Modest reductions in alcohol consumption were observed (e.g., 0.5 drinking day/wk), primarily in the inhibitory control group, and these effects were selective to alcohol use and did not extend to soda consumption. CONCLUSIONS These findings demonstrate the feasibility and acceptability of utilizing crowdsourcing methods for interventions development. Such a demonstration helps establish the crowdsourcing setting for future large sample studies testing novel interventions for AUD and other substance use disorders.
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Affiliation(s)
- Justin C Strickland
- Department of Psychology , University of Kentucky College of Arts and Sciences, Lexington, Kentucky
| | - J Chauncey Hill
- Department of Mathematics and Statistics , Washington University in St. Louis College of Arts and Sciences, St. Louis, Missouri
| | - William W Stoops
- Department of Psychology , University of Kentucky College of Arts and Sciences, Lexington, Kentucky.,Department of Behavioral Science , University of Kentucky College of Medicine, Lexington, Kentucky.,Department of Psychiatry , University of Kentucky College of Medicine, Lexington, Kentucky.,Center on Drug and Alcohol Research , University of Kentucky College of Medicine, Lexington, Kentucky
| | - Craig R Rush
- Department of Psychology , University of Kentucky College of Arts and Sciences, Lexington, Kentucky.,Department of Behavioral Science , University of Kentucky College of Medicine, Lexington, Kentucky.,Department of Psychiatry , University of Kentucky College of Medicine, Lexington, Kentucky
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Forster SE, DePhilippis D, Forman SD. "I's" on the prize: A systematic review of individual differences in Contingency Management treatment response. J Subst Abuse Treat 2019; 100:64-83. [PMID: 30898330 DOI: 10.1016/j.jsat.2019.03.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 01/30/2019] [Accepted: 03/06/2019] [Indexed: 01/02/2023]
Abstract
Contingency Management is an evidence-based treatment for substance use disorders with strong potential for measurement-based customization. Previous work has examined individual difference factors in Contingency Management treatment response of potential relevance to treatment targeting and adaptive implementation; however, a systematic review of such factors has not yet been conducted. Here, we summarize and evaluate the existing literature on patient-level predictors, mediators, and moderators of Contingency Management treatment response in stimulant and/or opioid using outpatients - clinical populations most frequently targeted in Contingency Management research and clinical practice. Our search strategy identified 648 unique, peer-reviewed publications, of which 39 met full inclusion criteria for the current review. These publications considered a variety of individual difference factors, including (1) motivation to change and substance use before and during treatment (8/39 publications), (2) substance use comorbidity and chronicity (8/39 publications), (3) psychiatric comorbidity and severity (8/39 publications), (4) medical, legal, and sociodemographic considerations (15/39 publications), and (5) cognitive-behavioral variables (1/39 publications). Contingency Management was generally associated with improved treatment outcomes (e.g., longer periods of continuous abstinence, better retention), regardless of individual difference factors; however, specific patient-level characteristics were associated with either an enhanced (e.g., more previous treatment attempts, history of sexual abuse, diagnosis of antisocial personality disorder) or diminished (e.g., complex post-traumatic stress symptoms, pretreatment benzodiazepine use) response to Contingency Management. Overall, the current literature is limited but existing evidence generally supports greater benefits of Contingency Management in patients who would otherwise have a poorer prognosis in standard outpatient care. It was also identified that the majority of previous work represents a posteriori analysis of pre-existing clinical samples and has therefore rarely considered pre-specified, hypothesis-driven individual difference factors. We therefore additionally highlight patient-level factors that are currently understudied, as well as promising future directions for measurement-based treatment adaptations that may directly respond to patient traits and states to improve Contingency Management effectiveness across individuals and over time.
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Affiliation(s)
- Sarah E Forster
- VISN 4 Mental Illness Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, United States of America; University of Pittsburgh, Department of Psychiatry, United States of America.
| | - Dominick DePhilippis
- Center of Excellence in Substance Addiction Treatment and Education, Corporal Michael J. Crescenz VA Medical Center, United States of America; Perelman School of Medicine, University of Pennsylvania, United States of America
| | - Steven D Forman
- VISN 4 Mental Illness Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, United States of America; University of Pittsburgh, Department of Psychiatry, United States of America
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39
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Berry J, Jacomb I, Lunn J, Sedwell A, Shakeshaft A, Kelly PJ, Sarrami P, James M, Russell S, Nardo T, Barker D, Holmes J. A stepped wedge cluster randomised trial of a cognitive remediation intervention in alcohol and other drug (AOD) residential treatment services. BMC Psychiatry 2019; 19:70. [PMID: 30760250 PMCID: PMC6372999 DOI: 10.1186/s12888-019-2044-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 01/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Executive functioning impairment is common in substance use disorder and is a major risk factor for poor treatment outcomes, including treatment drop-out and relapse. Cognitive remediation interventions seek to improve executive functioning and offer a promising approach to increase the efficacy of alcohol and other drug (AOD) treatments and improve long-term therapeutic outcomes. This protocol describes a study funded by the NSW Agency for Clinical Innovation that assesses the effectiveness of delivering a six-week group-based intervention of cognitive remediation in an ecologically valid sample of people attending residential AOD treatment services. We primarily aim to investigate whether cognitive remediation will be effective in improving executive functioning and treatment retention rates. We will also evaluate if cognitive remediation may reduce long-term AOD use and rates of health service utilisation, as well as improve personal goal attainment, quality of life, and client satisfaction with treatment. In addition, the study will involve an economic analysis of the cost of delivering cognitive remediation. METHODS/DESIGN The study uses a stepped wedge cluster randomised design, where randomisation will occur at the cluster level. Participants will be recruited from ten residential AOD treatment services provided by the non-government sector. The intervention will be delivered in 12 one-hour group-based sessions over a period of six weeks. All participants who are expected to receive treatment for the duration of the six-week intervention will be asked to participate in the study. The clusters of participants who are randomly assigned to the treatment condition will complete cognitive remediation in addition to treatment as usual (TAU). Primary and secondary outcome assessments will be conducted at pre-cognitive remediation/TAU phase, post-cognitive remediation/TAU phase, two-month follow-up, four-month follow-up, six-month follow-up, and eight-month follow-up intervals. DISCUSSION This study will provide comprehensive data on the effect of delivering a cognitive remediation intervention within residential AOD treatment services. If shown to be effective, cognitive remediation may be incorporated as an adjunctive intervention in current treatment programs. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Register (ANZCTR): ACTRN12618001190291 . Prospectively registered 17th July 2018.
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Affiliation(s)
- Jamie Berry
- 0000 0001 2158 5405grid.1004.5Macquarie University, Balaclava Road, North Ryde, NSW 2109 Australia ,Advanced Neuropsychological Treatment Services, PO Box 4070, Strathfield South, NSW 2136 Australia
| | - Isabella Jacomb
- 0000 0001 2158 5405grid.1004.5Macquarie University, Balaclava Road, North Ryde, NSW 2109 Australia
| | - Jo Lunn
- We Help Ourselves, PO Box 1779, Rozelle, NSW 2039 Australia
| | - Antoinette Sedwell
- Agency for Clinical Innovation, Level 4, 67 Albert Ave, Chatswood, NSW 2067 Australia
| | - Anthony Shakeshaft
- 0000 0004 4902 0432grid.1005.4National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2052 Australia
| | - Peter J Kelly
- 0000 0004 0486 528Xgrid.1007.6Illawarra Health and Medical Research Institute and the School of Psychology, Faculty of Social Sciences, University of Wollongong, Building 41, Room 128, Wollongong, NSW 2522 Australia
| | - Pooria Sarrami
- Agency for Clinical Innovation, Level 4, 67 Albert Ave, Chatswood, NSW 2067 Australia ,0000 0004 4902 0432grid.1005.4South Western Sydney Clinical School, University of New South Wales, Goulburn St, Liverpool, NSW 2170 Australia
| | - Megan James
- Agency for Clinical Innovation, Level 4, 67 Albert Ave, Chatswood, NSW 2067 Australia
| | - Skye Russell
- Agency for Clinical Innovation, Level 4, 67 Albert Ave, Chatswood, NSW 2067 Australia
| | - Talia Nardo
- Macquarie University, Balaclava Road, North Ryde, NSW, 2109, Australia.
| | - Daniel Barker
- 0000 0000 8831 109Xgrid.266842.cUniversity of Newcastle, University Drive, Callaghan, NSW 2308 Australia
| | - Jennifer Holmes
- Ministry of Health NSW, 73 Miller St, North Sydney, NSW 2060 Australia
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40
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Lechner WV, Sidhu NK, Kittaneh AA, Anand A. Interventions with potential to target executive function deficits in addiction: current state of the literature. Curr Opin Psychol 2019; 30:24-28. [PMID: 30797130 DOI: 10.1016/j.copsyc.2019.01.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 12/19/2018] [Accepted: 01/24/2019] [Indexed: 12/31/2022]
Abstract
The inability to stop or reduce substance use despite motivation to do so is thought to result, in part, from self-control failure and can be understood within the framework of dual process models of addiction. These models view addictive behavior as the relative balance between automatic impulses and executive decision processes. This review focuses on treatments that aim to improve executive decision processes which often become dysregulated and ineffective in individuals with substance use disorders. It is posited that improving these executive function deficits should restore control over automatic impulses and drug seeking behavior.
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Affiliation(s)
- William V Lechner
- Department of Psychological Sciences, Kent State University, 144 Kent Hall, P.O. Box 5190, Kent, OH 44242-0001, USA
| | - Natasha K Sidhu
- Department of Psychological Sciences, Kent State University, 144 Kent Hall, P.O. Box 5190, Kent, OH 44242-0001, USA
| | - Ahmad A Kittaneh
- Department of Psychological Sciences, Kent State University, 144 Kent Hall, P.O. Box 5190, Kent, OH 44242-0001, USA
| | - Amit Anand
- Center for Behavioral Health, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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Verdejo-Garcia A, Lorenzetti V, Manning V, Piercy H, Bruno R, Hester R, Pennington D, Tolomeo S, Arunogiri S, Bates ME, Bowden-Jones H, Campanella S, Daughters SB, Kouimtsidis C, Lubman DI, Meyerhoff DJ, Ralph A, Rezapour T, Tavakoli H, Zare-Bidoky M, Zilverstand A, Steele D, Moeller SJ, Paulus M, Baldacchino A, Ekhtiari H. A Roadmap for Integrating Neuroscience Into Addiction Treatment: A Consensus of the Neuroscience Interest Group of the International Society of Addiction Medicine. Front Psychiatry 2019; 10:877. [PMID: 31920740 PMCID: PMC6935942 DOI: 10.3389/fpsyt.2019.00877] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 11/06/2019] [Indexed: 01/01/2023] Open
Abstract
Although there is general consensus that altered brain structure and function underpins addictive disorders, clinicians working in addiction treatment rarely incorporate neuroscience-informed approaches into their practice. We recently launched the Neuroscience Interest Group within the International Society of Addiction Medicine (ISAM-NIG) to promote initiatives to bridge this gap. This article summarizes the ISAM-NIG key priorities and strategies to achieve implementation of addiction neuroscience knowledge and tools for the assessment and treatment of substance use disorders. We cover two assessment areas: cognitive assessment and neuroimaging, and two interventional areas: cognitive training/remediation and neuromodulation, where we identify key challenges and proposed solutions. We reason that incorporating cognitive assessment into clinical settings requires the identification of constructs that predict meaningful clinical outcomes. Other requirements are the development of measures that are easily-administered, reliable, and ecologically-valid. Translation of neuroimaging techniques requires the development of diagnostic and prognostic biomarkers and testing the cost-effectiveness of these biomarkers in individualized prediction algorithms for relapse prevention and treatment selection. Integration of cognitive assessments with neuroimaging can provide multilevel targets including neural, cognitive, and behavioral outcomes for neuroscience-informed interventions. Application of neuroscience-informed interventions including cognitive training/remediation and neuromodulation requires clear pathways to design treatments based on multilevel targets, additional evidence from randomized trials and subsequent clinical implementation, including evaluation of cost-effectiveness. We propose to address these challenges by promoting international collaboration between researchers and clinicians, developing harmonized protocols and data management systems, and prioritizing multi-site research that focuses on improving clinical outcomes.
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Affiliation(s)
- Antonio Verdejo-Garcia
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
| | - Valentina Lorenzetti
- School of Psychology, Faculty of Health Sciences, Australian Catholic University, Canberra, ACT, Australia
| | - Victoria Manning
- Eastern Health Clinical School Turning Point, Eastern Health, Richmond, VIC, Australia.,Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Hugh Piercy
- Eastern Health Clinical School Turning Point, Eastern Health, Richmond, VIC, Australia.,Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Raimondo Bruno
- School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Rob Hester
- School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - David Pennington
- San Francisco Veterans Affairs Health Care System (SFVAHCS), San Francisco, CA, United States.,Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
| | - Serenella Tolomeo
- School of Medicine, University of St Andrews, Medical and Biological Science Building, North Haugh, St Andrews, United Kingdom.,Department of Psychology, National University of Singapore, Singapore, Singapore
| | - Shalini Arunogiri
- Eastern Health Clinical School Turning Point, Eastern Health, Richmond, VIC, Australia.,Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Marsha E Bates
- Department of Kinesiology and Health, Rutgers University, New Brunswick, NJ, United States
| | | | - Salvatore Campanella
- Laboratoire de Psychologie Médicale et d'Addictologie, ULB Neuroscience Institute (UNI), CHU Brugmann-Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - Stacey B Daughters
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Christos Kouimtsidis
- Department of Psychiatry, Surrey and Borders Partnership NHS Foundation Trust, Leatherhead, United Kingdom
| | - Dan I Lubman
- Eastern Health Clinical School Turning Point, Eastern Health, Richmond, VIC, Australia
| | - Dieter J Meyerhoff
- DVA Medical Center and Department of Radiology and Biomedical Imaging, University of California San Francisco, School of Medicine, San Francisco, CA, United States
| | - Annaketurah Ralph
- School of Psychology, University of Queensland, Brisbane, QLD, Australia
| | - Tara Rezapour
- Department of Cognitive Psychology, Institute for Cognitive Sciences Studies, Tehran, Iran
| | - Hosna Tavakoli
- Department of Cognitive Psychology, Institute for Cognitive Sciences Studies, Tehran, Iran.,Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehran Zare-Bidoky
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran.,School of Medicine, Shahid-Sadoughi University of Medical Sciences, Yazd, Iran
| | - Anna Zilverstand
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, United States
| | - Douglas Steele
- Medical School, University of Dundee, Ninewells Hospital, Scotland, United Kingdom
| | - Scott J Moeller
- Department of Psychiatry, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United States
| | - Martin Paulus
- Laureate Institute for Brain Research, University of Tulsa, Tulsa, OK, United States
| | - Alex Baldacchino
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
| | - Hamed Ekhtiari
- Laureate Institute for Brain Research, University of Tulsa, Tulsa, OK, United States
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Butler K, Le Foll B. Impact of Substance Use Disorder Pharmacotherapy on Executive Function: A Narrative Review. Front Psychiatry 2019; 10:98. [PMID: 30881320 PMCID: PMC6405638 DOI: 10.3389/fpsyt.2019.00098] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 02/11/2019] [Indexed: 12/20/2022] Open
Abstract
Substance use disorders are chronic, relapsing, and harmful conditions characterized by executive dysfunction. While there are currently no approved pharmacotherapy options for stimulant and cannabis use disorders, there are several evidence-based options available to help reduce symptoms during detoxification and aid long-term cessation for those with tobacco, alcohol and opioid use disorders. While these medication options have shown clinical efficacy, less is known regarding their potential to enhance executive function. This narrative review aims to provide a brief overview of research that has investigated whether commonly used pharmacotherapies for these substance use disorders (nicotine, bupropion, varenicline, disulfiram, acamprosate, nalmefene, naltrexone, methadone, buprenorphine, and lofexidine) effect three core executive function components (working memory, inhibitory control and cognitive flexibility). While pharmacotherapy-induced enhancement of executive function may improve cessation outcomes in dependent populations, there are limited and inconsistent findings regarding the effects of these medications on executive function. We discuss possible reasons for the mixed findings and suggest some future avenues of work that may enhance the understanding of addiction pharmacotherapy and cognitive training interventions and lead to improved patient outcomes.
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Affiliation(s)
- Kevin Butler
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Bernard Le Foll
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada.,Alcohol Research and Treatment Clinic, Acute Care Program, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada.,Division of Brain and Therapeutics, Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
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43
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Gunn RL, Gerst KR, Wiemers EA, Redick TS, Finn PR. Predictors of Effective Working Memory Training in Individuals with Alcohol Use Disorders. Alcohol Clin Exp Res 2018; 42:2432-2441. [PMID: 30247753 PMCID: PMC6286203 DOI: 10.1111/acer.13892] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 09/16/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Low working memory (WM) capacity is associated with alcohol use disorders (AUDs). The importance of WM to adaptive functioning has led to a recent influx of studies attempting to improve individual WM capacity using various cognitive training methods. The present study aimed to examine the efficacy of complex WM training for improving WM capacity among individuals with AUD. METHODS Individuals were randomized to complete either adaptive WM training or active control training. We applied a methodologically rigorous and structured approach, including a battery of near and moderate transfer measures in those with AUDs and a control group. Additionally, we examined cognitive factors (at baseline) and other predictors of adherence, training task improvement, and transfer. RESULTS Results suggest improved WM in individuals with AUDs and controls, as evidenced by improved scores on several transfer measures, after adaptive WM training. However, individuals with AUDs showed poorer adherence and less improvement on the training tasks themselves. Neither IQ, WM, sex, nor condition predicted adherence. Level of training task performance, baseline WM, and IQ predicted transfer task improvement. CONCLUSIONS This is the first study to rigorously examine both the efficacy of WM training in those with AUDs, and predictors of successful training program adherence and transfer in a large sample. Among study completers, results suggest that AUD status does not predict training improvement and transfer. However, AUD status did predict lower program adherence. WM training was more effective in those with higher cognitive ability at baseline. This study provides direct translation to the development of cognitive interventions for treating AUD.
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Affiliation(s)
- Rachel L Gunn
- Center for Alcohol and Addiction Studies , Brown University School of Public Health, Providence, Rhode Island
| | - Kyle R Gerst
- Department of Psychological and Brain Sciences , Indiana University-Bloomington, Bloomington, Indiana
| | - Elizabeth A Wiemers
- Department of Psychological Sciences , Purdue University, West Lafayette, Indiana
| | - Thomas S Redick
- Department of Psychological Sciences , Purdue University, West Lafayette, Indiana
| | - Peter R Finn
- Department of Psychological and Brain Sciences , Indiana University-Bloomington, Bloomington, Indiana
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Khemiri L, Brynte C, Stunkel A, Klingberg T, Jayaram-Lindström N. Working Memory Training in Alcohol Use Disorder: A Randomized Controlled Trial. Alcohol Clin Exp Res 2018; 43:135-146. [PMID: 30462837 PMCID: PMC6587824 DOI: 10.1111/acer.13910] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 10/14/2018] [Indexed: 11/29/2022]
Abstract
Background Alcohol use disorder (AUD) is associated with cognitive deficits such as impaired executive functions, which are hypothesized to contribute to the progression of the disease and worsen treatment outcome. Training of working memory (WM) to improve cognitive functions and thereby reduce alcohol use has been proposed as a novel treatment strategy. Methods Patients with AUD (n = 50) who were recruited to an outpatient addiction clinic were randomized to receive 5 weeks of active WM training or control training. Participants had weekly follow‐up visits, and all cognitive training sessions were done online at home. Primary outcomes were WM function and change in self‐reported heavy drinking. Secondary outcomes were craving, other drinking outcomes, and performance on a range of neuropsychological tasks from the Cambridge Neuropsychological Test Automated Battery. Results The active training group demonstrated a significantly greater improvement in verbal WM compared with the control group. No statistically significant effect of training was found on the primary drinking outcome, but a trend was observed indicating that WM training reduces the number of drinks per drinking occasion. WM training had no statistically significant effect on any of the other neuropsychological tasks. Conclusions Cognitive training can improve WM function in individuals with AUD, suggesting that such interventions are feasible to administer in this patient population. The results do not support an effect of WM training on heavy drinking or transfer effects to other cognitive domains. Future studies should evaluate WM training as an adjunct to evidence‐based treatments for AUD to assess potential synergistic effects.
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Affiliation(s)
- Lotfi Khemiri
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden.,Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Christoffer Brynte
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden.,Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Angela Stunkel
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden.,Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Torkel Klingberg
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Nitya Jayaram-Lindström
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden.,Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
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Kim EJ, Bahk YC, Oh H, Lee WH, Lee JS, Choi KH. Current Status of Cognitive Remediation for Psychiatric Disorders: A Review. Front Psychiatry 2018; 9:461. [PMID: 30337888 PMCID: PMC6178894 DOI: 10.3389/fpsyt.2018.00461] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 09/05/2018] [Indexed: 12/22/2022] Open
Abstract
Cognition is an important factor that affects daily functioning and quality of life. Impairment in cognitive function is a common symptom present in various psychological disorders, which hinders patients from functioning normally. Given that cognitive impairment has devastating effects, enhancing this in patients should lead to improvements in compromised quality of life and functioning, including vocational functioning. Over the past 50 years, several attempts have been made to improve impaired cognition, and empirical evidence for cognitive remediation (CR) has accumulated that supports its efficacy for treating schizophrenia. More recently, CR has been successfully applied in the treatment of depressive disorders, bipolar disorders, attention deficit/hyperactivity disorder, and anorexia nervosa. This study critically reviews recent CR studies and suggests their future direction. This study aimed to provide a modern definition of CR, and examine the current status of empirical evidence and representative CR programs that are widely used around the world.
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Affiliation(s)
- Eun Jin Kim
- Department of Psychology, Korea University, Seoul, South Korea
| | - Yong-Chun Bahk
- Department of Psychology, Korea University, Seoul, South Korea
| | - Hyeonju Oh
- Department of Psychology, Korea University, Seoul, South Korea
| | - Won-Hye Lee
- Department of Clinical Psychology, National Center for Mental Health, Seoul, South Korea
| | - Jong-Sun Lee
- Department of Psychology, Kangwon National University, Chuncheon, South Korea
| | - Kee-Hong Choi
- Department of Psychology, Korea University, Seoul, South Korea
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46
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Neuropsychological Interventions for Decision-Making in Addiction: a Systematic Review. Neuropsychol Rev 2018; 29:79-92. [DOI: 10.1007/s11065-018-9384-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 08/17/2018] [Indexed: 11/25/2022]
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Schulte MHJ, Wiers RW, Boendermaker WJ, Goudriaan AE, van den Brink W, van Deursen DS, Friese M, Brede E, Waters AJ. Reprint of The effect of N-acetylcysteine and working memory training on cocaine use, craving and inhibition in regular cocaine users: correspondence of lab assessments and Ecological Momentary Assessment. Addict Behav 2018; 83:79-86. [PMID: 29661657 DOI: 10.1016/j.addbeh.2018.03.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 11/21/2017] [Accepted: 11/29/2017] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Effective treatment for cocaine use disorder should dampen hypersensitive cue-induced motivational processes and/or strengthen executive control. Using a randomized, double-blind, placebo-controlled intervention, the primary aim of this study was to investigate the effect of N-Acetylcysteine (NAC) and working memory (WM)-training to reduce cocaine use and craving and to improve inhibition assessed in the laboratory and during Ecological Momentary Assessment (EMA). The second aim was to examine correspondence between laboratory and EMA data. METHODS Twenty-four of 38 cocaine-using men completed a 25-day intervention with 2400mg/day NAC or placebo and WM-training as well as two lab-visits assessing cocaine use, craving and inhibition (Stop Signal task). Additionally, cocaine use, craving and cognition (Stroop task) were assessed using EMA during treatment, with 26 participants completing 819 assessments. RESULTS Cocaine problems according to the Drug Use Disorder Identification Test (DUDIT) decreased more after NAC than after placebo, and the proportion of cocaine-positive urines at lab-visit 2 was lower in the NAC group. No NAC effects were found on craving. For cocaine use and craving, results from the lab data were generally similar to EMA results. NAC also showed some effects on cognitive control: improved inhibition assessed with the Stop Signal task in the lab, and decreased classic Stroop performance during EMA. There were no significant effects of number of completed WM-training sessions. CONCLUSIONS Overall this study revealed mixed findings regarding the treatment of cocaine use disorders with NAC and WM-training. The effect of NAC on inhibition should be further investigated.
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Affiliation(s)
- Mieke H J Schulte
- Addiction, Development, and Psychopathology (ADAPT) Lab, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands; Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | - Reinout W Wiers
- Addiction, Development, and Psychopathology (ADAPT) Lab, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Wouter J Boendermaker
- Addiction, Development, and Psychopathology (ADAPT) Lab, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands; Department of Experimental Psychology, Utrecht University, The Netherlands
| | - Anna E Goudriaan
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Arkin Mental Health, Amsterdam, The Netherlands
| | - Wim van den Brink
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Denise S van Deursen
- Addiction, Development, and Psychopathology (ADAPT) Lab, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands; Faculty of Psychology and Educational Sciences, Open University of The Netherlands, Heerlen, The Netherlands
| | - Malte Friese
- Department of Psychology, Saarland University, Saarbruecken, Germany
| | - Emily Brede
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Andrew J Waters
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
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Zhu Y, Jiang H, Su H, Zhong N, Li R, Li X, Chen T, Tan H, Du J, Xu D, Yan H, Xu D, Zhao M. A Newly Designed Mobile-Based Computerized Cognitive Addiction Therapy App for the Improvement of Cognition Impairments and Risk Decision Making in Methamphetamine Use Disorder: Randomized Controlled Trial. JMIR Mhealth Uhealth 2018; 6:e10292. [PMID: 29925497 PMCID: PMC6031898 DOI: 10.2196/10292] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 05/10/2018] [Accepted: 05/29/2018] [Indexed: 12/21/2022] Open
Abstract
Background Cognitive rehabilitation therapy has been found to improve cognitive deficits and impulse control problems in methamphetamine use disorder (MUD). However, there is limited research regarding this therapy’s feasibility when using mobile-based health technologies in supporting recovery from MUD in China. Objective The main aim of this study was to test whether 4 weeks of a newly designed computerized cognitive addiction therapy (CCAT) app can improve cognitive impairments, eliminate drug-related attention bias, and attenuate risk decision-making behaviors in participants with MUD. Methods Forty MUD participants were assigned randomly to either the CCAT group (n=20), who received 4 weeks of CCAT plus regular detoxification treatment as usual, or the control group (n=20), who only received the regular detoxification treatment as usual, in drug rehabilitation centers in Shanghai. The CCAT was designed by combine methamphetamine use-related picture stimuli with cognitive training with the aim of improving cognitive function and eliminating drug-related attention bias. The CogState Battery, Delay Discounting Task (DDT), Iowa Gambling Task (IGT), and Balloon Analog Risk Task (BART) were administered face-to-face to all participants before and after CCAT interventions. Results Forty male patients were recruited. The mean age was 32.70 (SD 5.27) years in the CCAT group and mean 35.05 (SD 8.02) years in the control group. Compared to the control group, CCAT improved working memory in the CCAT group (P=.01). Group×time interactions were observed among DDT, IGT, and BART tasks, with rates of discounting delayed rewards, IGT, and BART scores (P<.001) being reduced among those who received CCAT, whereas no changes were found in the control group. Conclusions The newly designed CCAT can help to improve cognitive impairment and impulsive control in MUD. Further study is needed to understand the underlying brain mechanisms of the cognitive therapy. Trial Registration ClinicalTrials.gov NCT03318081; https://clinicaltrials.gov/ct2/show/NCT03318081 (Archived by WebCite at https://clinicaltrials.gov/ct2/show/NCT03318081)
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Affiliation(s)
- Youwei Zhu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haifeng Jiang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hang Su
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Na Zhong
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Runji Li
- Shanghai South West Weiyu Middle School, Shanghai, China
| | - Xiaotong Li
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tianzhen Chen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haoye Tan
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiang Du
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ding Xu
- Shanghai Bureau of Drug Rehabilitation Administration, Shanghai, China
| | - Huan Yan
- Shanghai Qingdong Compulsory Drug Dependence Rehablitation Center, Shanghai, China
| | - Dawen Xu
- Shanghai Qingdong Compulsory Drug Dependence Rehablitation Center, Shanghai, China
| | - Min Zhao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
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Harris DJ, Wilson MR, Vine SJ. A Systematic Review of Commercial Cognitive Training Devices: Implications for Use in Sport. Front Psychol 2018; 9:709. [PMID: 29867674 PMCID: PMC5958310 DOI: 10.3389/fpsyg.2018.00709] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 04/23/2018] [Indexed: 12/25/2022] Open
Abstract
Background: Cognitive training (CT) aims to develop a range of skills, like attention and decision-making, through targeted training of core cognitive functions. While CT can target context specific skills, like movement anticipation, much CT is domain general, focusing on core abilities (e.g., selective attention) for transfer to a range of real-world tasks, such as spotting opponents. Commercial CT (CCT) devices are highly appealing for athletes and coaches due to their ease of use and eye-catching marketing claims. The extent to which this training transfers to performance in the sporting arena is, however, unclear. Therefore, this paper sought to provide a systematic review of evidence for beneficial training effects of CCT devices and evaluate their application to sport. Methods: An extensive search of electronic databases (PubMed, PsychInfo, GoogleScholar, and SportDiscus) was conducted to identify peer-reviewed evidence of training interventions with commercially available CT devices. Forty-three studies met the inclusion criteria and were retained for quality assessment and synthesis of results. Seventeen studies assessed transfer effects beyond laboratory cognitive tests, but only 1 directly assessed transfer to a sporting task. Results: The review of evidence showed limited support for far transfer benefits from CCT devices to sporting tasks, mainly because studies did not target the sporting environment. Additionally, a number of methodological issues with the CCT literature were identified, including small sample sizes, lack of retention tests, and limited replication of findings by researchers independent of the commercial product. Therefore, evidence for sporting benefits is currently limited by the paucity of representative transfer tests and a focus on populations with health conditions. Conclusions: Currently there is little direct evidence that the use of CCT devices can transfer to benefits for sporting performance. This conclusion, however, stems more from a lack of experimental studies in the sporting field and a lack of experimental rigor, rather than convincing null effects. Subsequently, there is an opportunity for researchers to develop more reliable findings in this area through systematic assessment in athletic populations and major methodological improvements.
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Affiliation(s)
- David J Harris
- Sport and Health Sciences, University of Exeter, Exeter, United Kingdom
| | - Mark R Wilson
- Sport and Health Sciences, University of Exeter, Exeter, United Kingdom
| | - Samuel J Vine
- Sport and Health Sciences, University of Exeter, Exeter, United Kingdom
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50
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Naudé GP, Kaplan BA, Reed DD, Henley AJ, DiGennaro Reed FD. Temporal framing and the hidden-zero effect: rate-dependent outcomes on delay discounting. J Exp Anal Behav 2018; 109:506-519. [DOI: 10.1002/jeab.328] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 03/29/2018] [Indexed: 11/12/2022]
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